Gout Flashcards
What is Gout?
a type of crystal arthropathy associated with chronically high blood uric acid levels
Gout results from the deposition of monosodium urate crystals in joints and soft tissues.
What is the most commonly involved joint in acute gout?
1st metatarsophalangeal joint (podagra)
- also CMCJ
This joint is typically affected at presentation.
What causes the symptoms of gout?
Deposition of monosodium urate (MSU) crystals in joints and soft tissues
This leads to acute and chronic arthritis, tophi, urate nephropathy, and nephrolithiasis.
What percentage of patients experience a second flare within 1 year after an initial gout attack?
60%
This increases to 78% within 2 years.
What is the management strategy for gout?
Treat acute attacks and prevent recurrence by reducing SUA levels
Management includes medication and lifestyle adjustments.
What are the non-modifiable risk factors for gout?
Age >40 years
male gender
FHx
These factors cannot be changed.
List some modifiable risk factors for gout.
- 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.
What are the main urate-lowering therapies (ULT) for chronic gout?
- Allopurinol
- Febuxostat
Both are xanthine oxidase inhibitors that reduce urate formation.
What is the aim for serum uric acid (SUA) levels in gout management?
Reduce SUA to < 360 micromol/L
This target helps in managing gout effectively.
True or False: Asymptomatic hyperuricemia requires treatment.
False
Asymptomatic hyperuricemia does not necessitate treatment.
What is a pathognomonic finding for gout in synovial fluid?
MSU crystals
These crystals are indicative of gout when found in fluid aspirate.
What is the first line treatment for acute gout?
- NSAIDs e.g. naproxen + PPI
- Colchicine 2nd
- oral steroids 3rd
These treatments are most effective when initiated within 24 hours of an acute flare.
What is pseudogout?
An important differential diagnosis of gout caused by calcium pyrophosphate crystals
Pseudogout mainly occurs in older women with osteoarthritis.
Fill in the blank: Regular _______ can help prevent gout.
exercise
Maintaining a healthy lifestyle is crucial in gout prevention.
What lifestyle modifications can help prevent gout?
- 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.
What is gout associated with
High risk of CVD
What therapies are indicated in chronic cases of gout
Urate lowering therapies (ULTs) after acute attack
- allopurinol and febuxostat which are both xanthine oxidase inhibitors and reduce urate formation
What alternative drug therapies can be used to treat gout and how effective are they
Benzbromarone and sulfinpyrazone are LESS commonly used due to more side effects - they act increase renal excretion of uric acid
how does gout typically present
single acute hot, swollen and painful joint
what might X-ray of a joint affected by gout show
- Maintained joint space (no loss of joint space)
- Lytic lesions in the bone
- Punched out erosions
- Erosions can have sclerotic borders with overhanding edges
when is use of colchicine indicated for treatment of gout
- used in pt where NSAIDs are contraindicated e.g. renal impairment or significant heart disease
- abdo symptoms + diarrhoea may be common side effects
- very dangerous in overdose and can cause multiple organ failure
- only prescribed for short course up to 6mg per course
what are prophylactic interventions for gout
xanthine oxidase inhibitors which lower uric acid levels
- allopurinol
- febuxostat
prophylaxis is NOT started until weeks after the acute attack has resolved. once either one of the above is started, it is then continued during an acute attack
what is a typical presentation of pseudogout
patient over 65 years old with a rapid-onset hot, swollen, stiff and painful knee
Other commonly affected joints are the shoulders, hips and wrists
what investigations are used to reach a diagnosis of pseudogout
exclude septic arthritis 1st!!!!
- joint aspiration: calcium pyrophosphate (rhomboid shaped positively birefringent of polarised light)
- X-ray: chondrocalcinosis where calcium deposits in the joint cartilage show up as thin white line in middle of joint space
