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inflammatory arthritis > gout > Flashcards

gout Flashcards

1
Q

what is it?

A

potentially disabling and erosive inflammatory arthritis

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2
Q

what causes it?

A

deposition of monosodium urate crystals into joints and soft tissues

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3
Q

what are some causes?

A

high serum uric acid levels (hyperuricaemia)

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4
Q

what are causes if increased urate production?

A

high dietary purine intake
alcohol
inherited enzyme defects
psoriasis
haemolytic disorders

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5
Q

what are causes of reduced urate excretion?

A

chronic renal impairment
volume depletion
hypothyroidism
thiazide diuretics
cytotoxins

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6
Q

what are risk factors?

A

age - rare under 20, dec after 80
men
rare in women before menopause

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7
Q

what is pathophysiology or hyperuricaemia?

A

uric acid = final compound in breakdown of purines in DNA metabolism
recurrent gout flares = result of acute inflammatory response to deposited MSU crystals
chronic gouty arthritis and tophaceous gout is result of chronic granulomatous inflammatory response to deposited crystals

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8
Q

what is the histology of gouty tophi?

A

amorphous eosinophilic debris and inflammation (giant cells)

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9
Q

what is acute gout?

A

crystals deposited, trying to get rid

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10
Q

what is clinical presentation of acute gout?

A

monoarthiritis
1 metatarsalphalangeal (MTP)
severe pain, hot swollen joint - mimic septic arthritis
abrupt onset - overnight
settles in 10 days no treatment, 3 days with

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11
Q

what are gouty tophi?

A

painless white accumulations of uric acid which can occur in soft tissues and occasionally erupt through skin

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12
Q

what is clinical presentation of chronic tophaceous gout?

A

often diuretic associated
may get acute attacks
result in destructive erosive arthritis

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13
Q

what investigations are used?

A

bloods
aspiration of synovial fluid
x-ray

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14
Q

what is seen on bloods?

A

serum uric acid raised
raised inflammatory markers
renal function - rule out renal impairment

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15
Q

what is seen on aspiration of synovial fluid? BUZZWORD

A

needle shaped, negative birefringent crystals
gram stain - rule out septic

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16
Q

what is 1st line management?

A

NASAIDS e.g. naproxen

17
Q

what is naproxen contraindicated in?

A

renal impairment

18
Q

what is 2nd line treatment?

A

colchicine

19
Q

which patients would colchicine be used in?

A

HF, CKD

20
Q

what is side effect of colchicine?

A

diarrhoea

21
Q

what is 3rd line management?

A

steroids

22
Q

what are indications for prophylaxis therapy?

A

2 + acute attacks despite lifestyle mods
gouty tophi
HF when unable to stop diuretics

23
Q

what is the target serum uric acid by WHO?

A

300-600

24
Q
A

inflammatory arthritis (9 decks)

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