Gout

Question 1

Gout

Answer 1

• joint swelling and pain
• first metatarsophalangeal ( big toe) joint
• high uric acid levels in blood
• monosodium urate crystals form inside around joints

Question 2

GOUT - HYPERURICAEMIA

Answer 2

• increased levels of plasma uric acid ( urate )

INCREASE URATE PRODUCTION
- diet uptake
- obesity
- haematological excretion

REDUCED RENAL URATE EXCRETION
- drugs
- renal function
- obesity

Question 3

GOUT PATHOPHYSIOLOGY

Answer 3

• MSU crystals
• recognition by toll like receptors
• release of IL-1
• neutrophils recruitment
• tophus/tophi

Question 4

Symptoms/Diagnosis

Answer 4

• one joint
• extremely painful
• swelling, warm, redness
• rapid onset of severe pain
• measure serum urate levels to confirm

-Blood test
-Joint fluid analysis
-imaging tests

Question 5

Treatment

Answer 5

ACUTE GOUT
- remove precipitating cause
- rest affected joints
- drugs

PROPHYLACTIC TREATMENT
- xanthine oxidase inhibitors ( allopurinol )
- uricosuric drugs

NON PHARMACOLOGICAL
- low purine diet
- reduce weight
- reduce alcohol intake
- exercise

Question 6

Patient which need additional expertise

Answer 6

• suspected underlying systemic illness
• gout in pregnancy
• gout in someone under 30
• CKD stages 3 to 5
• previous organ transplant
• repeat attack and not on preventative treatment

Question 7

Complications

Answer 7

• chronic arthritis
• joint damage
• renal stones
  tophi

HYPERURICAEMIA IS ASSOCIATED WITH AN INCREASED RISK OF :
- CVD
-CKD
- Diabetes

Question 8

Self care during attack

Answer 8

• apply ice packs to reduce pain
• rest and elevate the limb
• keep the joint exposed and in a cool environment
• consider the use of an ice pack or bed cage
  -return if symptoms get worse and if they do not improve in 1 -2 days