Gout

Question 1

Presentation

Answer 1

Asymmetrical deformity and swelling of the small joints of the hands
Tophi

Question 2

Where are the tophi?

Answer 2

Hands, forearms, ears

Question 3

Differential of a single inflamed joint

Answer 3

Septic arthritis, crystal arthritis, spondyloarthropathy, OA

Question 4

Questions for monoarthritis

Answer 4

Onset
Fever
Previous joint disease
History of trauma
Distribution
Symptoms of systemic disease
Associated features
Recent travel
Predisposing factors

Question 5

Investigations for monoarthritis

Answer 5

Joint aspiration
BC

Question 6

Pathophysiology of gout

Answer 6

Hyperuricaemia due to:
Decreased renal excretion - idiopathic, HTN, increased levels of organic acids, dehydration, CKD, drugs
Increased purine production - idiopathic, lymphoproliferative/myeloproliferative,

Question 7

Treatment

Answer 7

Rest
Rehydration
NSAIDs - or colchicine
Steroids

Question 8

Longterm treatment

Answer 8

Lifestyle measures
Allopurinol - xanthine oxidase inhibitor, prevents urate formation

Question 9

CPPD

Answer 9

Pseudogout - calcium pyrophosphate deposition - positive birefringent - found in knee. Chondrocalcinosis

Question 10

Common infective causes of arthritis

Answer 10

Bacterial - non-gonococcal - haematogenous spread - Staphylococci (or streptococci in splenic dysfunction
Gonococcal arthritis
Mycobacterial arthritis
Lyme disease