Gout

Question 1

What is Gout?

Answer 1

Inflammatory arthritis related to hyperuricemia

Gout results from the deposition of monosodium urate crystals in joints and soft tissues.

Question 2

What is the most commonly involved joint in acute gout?

Answer 2

1st metatarsophalangeal joint (podagra)

This joint is typically affected at presentation.

Question 3

What causes the symptoms of gout?

Answer 3

Deposition of monosodium urate (MSU) crystals in joints and soft tissues

This leads to acute and chronic arthritis, tophi, urate nephropathy, and nephrolithiasis.

Question 4

What percentage of patients experience a second flare within 1 year after an initial gout attack?

Answer 4

60%

This increases to 78% within 2 years.

Question 5

What is the management strategy for gout?

Answer 5

Treat acute attacks and prevent recurrence by reducing SUA levels

Management includes medication and lifestyle adjustments.

Question 6

What are the non-modifiable risk factors for gout?

Answer 6

Age >40 years, Male gender

These factors cannot be changed.

Question 7

List some modifiable risk factors for gout.

Answer 7

• Increased purine uptake (meats and seafood)
• Alcohol intake (especially beer)
• High fructose intake
• Obesity
• Congestive heart failure
• Coronary artery disease
• Dyslipidemia
• Renal disease
• Organ transplant
• Hypertension
• Smoking
• Diabetes mellitus
• Urate-elevating medications (e.g., diuretics)

Modifiable factors can be addressed through lifestyle changes.

Question 8

What are the main urate-lowering therapies (ULT) for chronic gout?

Answer 8

• Allopurinol
• Febuxostat

Both are xanthine oxidase inhibitors that reduce urate formation.

Question 9

What is the aim for serum uric acid (SUA) levels in gout management?

Answer 9

Reduce SUA to < 360 micromol/L

This target helps in managing gout effectively.

Question 10

True or False: Asymptomatic hyperuricemia requires treatment.

Answer 10

False

Asymptomatic hyperuricemia does not necessitate treatment.

Question 11

What is a pathognomonic finding for gout in synovial fluid?

Answer 11

MSU crystals

These crystals are indicative of gout when found in fluid aspirate.

Question 12

What is the first line treatment for acute gout?

Answer 12

• NSAIDs
• Oral/IM steroids
• Colchicine

These treatments are most effective when initiated within 24 hours of an acute flare.

Question 13

What is pseudogout?

Answer 13

An important differential diagnosis of gout caused by calcium pyrophosphate crystals

Pseudogout mainly occurs in older women with osteoarthritis.

Question 14

Fill in the blank: Regular _______ can help prevent gout.

Answer 14

exercise

Maintaining a healthy lifestyle is crucial in gout prevention.

Question 15

What lifestyle modifications can help prevent gout?

Answer 15

• Maintain optimal weight
• Regular exercise
• Diet modification (reduce purine-rich foods)
• Reduce alcohol consumption
• Smoking cessation
• Maintain fluid intake

These changes can significantly reduce the risk of gout attacks.

Question 16

What is gout associated with

Answer 16

High risk of CVD

Question 17

What therapies are indicated in chronic cases of gout

Answer 17

Urate lowering therapies (ULTs) after acute attack
- allopurinol and febuxostat which are both xanthine oxidase inhibitors and reduce urate formation

Question 18

What alternative drug therapies can be used to treat gout and how effective are they

Answer 18

Benzbromarone and sulfinpyrazone are LESS commonly used due to more side effects - they act increase renal excretion of uric acid