Gout Flashcards
What is gout?
A type of crystal arthropathy associated with chronically high serum uric acid levels
What are gouty tophi?
Subcutaneous uric acid deposits
What are the risk factors for gout?
Male
Family history
Obesity
High purine diet
Alcohol
Diuretics
Cardiovascular disease
What is the pathophysiology of gout?
Uric acid builds up as a cause of either uric acic overproduction or reduced excretion of uric acid
What are the causes of overproduction of uric acid?
Increased cell turnover
Cytotoxic drugs
Purine rich diet
Obesity
What are the causes of reduced excretion of uric acid?
CKD
Diuretics
Pyrazinamide
Lead toxicity
What are the most commonly affected joints in gout?
Base of the big toe (metatarsophalangeal joint)
Base of the big thumb (carpmetacarpal joint)
What is the presentation of gout?
Rapid onset severe joint pain
Joint stiffness
Joint erythema and swelling
Gouty tophi
What investigations are used in the diagnosis of gout?
Joint aspiration - needle shaped crystals with negative birefringence
Serum urate (4-6 weeks after attack resolves)
Joint XR
What changes are seen on joint XR in gout?
Maintained joint space
Lytic lesions in the bone
Punched out erosions
Erosions can have sclerotic borders and overhanging edges
What is the management of an acute flare of gout?
First line - NSAIDs (naproxen)
Second line - colchicine
Third line - oral steroids
What is the first line prophylaxis of gout?
Allopurinol
- Xanthine oxidase inhibitor
What is second line for the prophylaxis of gout?
Febuxostate - if allopurinol is not tolerated or is not effective
