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Musculoskeletal > Gout > Flashcards

Gout Flashcards

1
Q

What is gout?

A

Gout is a potentially disabling and erosive inflammatory arthritis cused by the deposition of monosodium urate (Uric acid) crystals into joints and soft tissue

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2
Q

Who is most at risk of developing gout?

A

People between the ages of 20 and 80
It is more common in men than women
It is very rare in women before the menopause

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3
Q

What are the 2 pathways of developing hyperuricaemia?

A

Increased uric acid production
Reduced uric acid excretion

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4
Q

What are some causes of increased uric acid production?

A
  • Inherited enzyme deficiency (Lesch Nyhan)
  • Myeloproliferative or lymphoproliferative disorders
  • Psoriasis
  • High alcohol intake
  • High dietary purine intake (Red meat, seafood, corn syrup)
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5
Q

What are some causes of reduced uric acid excretion?

A
  • Chronic renal impairment
  • Volume depletion (e.g. heart failure)
  • Hypothyroidism
  • Diuretics
  • Cytotoxics (e.g. ciclosporin)
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6
Q

Where does uric acid in the body come from?

A

From purines gained from:
DNA metabolism
Dietary intake (Red meat, seafood)

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7
Q

Describe the breakdown of purines into uric acid

A

Purine =>
Hypoxanthine =>
Xanthine =>
Plasma urate =>
Uric acid

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8
Q

What uric acid level is described as hyperuricaemia?

A

> 0.42 mmol/L

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9
Q

How does hyperuricaemia lead to gout?

A

Hyperuricaemia =>
Precipitation of urate crystals in joints =>
Complement activation and phagocytosis =>
Neutrophil chemotaxis =>
Release of lysosomal enzymes, LTB4 and prostaglandins =>
Phagocytosis leads to release of IL-1, TNF. IL-6 and IL-8 =>
Tissue injury and inflammation

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10
Q

How does acute gout present?

A

Monoarthropathy with severe pain and hot, swollen joints
Abrupt onset which occurs overnight

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11
Q

What are the most commonly affected joints in gout?

A

MTP joints
Ankle joints
Knee joints

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12
Q

How long will symptoms of an acute gout flare up last without treatment?

A

10 days

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13
Q

How long will symptoms of an acute gout flare up last with treatment?

A

3 days

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14
Q

What is chronic topahaceous gout?

A

Chronic joint inflammation in gout and is often associated with diuretics

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15
Q

How will chronic tophaceous gout usually present?

A

This results in granulomatous tophi formation, containing eosinophilic debris and inflammation

These are usually painless

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16
Q

What tests are usually required in gout diagnosis?

A

Serum uric acid
Bloods
Polarised microscopy of synovial fluid
X-ray

17
Q

What will be shown on blood tests in gout?

A

Raised inflammatory markers

18
Q

What will be seen on polarised microscopy of synovial fluid in gout?

A

Needle-shaped, negative birefringent crystals

19
Q

What will X-ray show in long-standing gout?

A

Joint erosion

20
Q

What lifestyle modifications are required in gout?

A

Reduction of alcohol intake
Reduction of purine intake

21
Q

How are acute gout flare-ups treated?

A

NSAIDs
Colchicine
Steroids

22
Q

What medication can be given to prevent further flare-ups of gout?

A

Xanthine oxidase inhibitors (Allopurinol, febuxostat)
Uricosuric drugs (sulfinpyrazone, probenecid, benzbromarone)

23
Q

What are some examples of Xanthine oxidase inhibitors?

A

Allopurinol
Febuxostat

24
Q

What are some examples of uricosuric drugs?

A

Sulfinpyrazone
Probenecid
Benzbromarone

25
Q

When should prophylactic prevention of further flare-ups be started in gout?

A

1 week after an acute attack, with NSAIDs or colchicine being given during this week

26
Q

What is the WHO target for serum uric acid in gout treatment?

A

0.3-0.36 mmol/L

27
Q

Who is prophylactic management of gout indicated in?

A

Those with one or more attacks in a year, despite lifestyle modification
Those with gouty tophi
Those with chronic renal impairment
Those with heart failure
Those on chemotherapy

28
Q
A

Musculoskeletal (123 decks)

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