Gout Flashcards
What is gout?
A type of crystal arthropathy associated with chronically high uric acid levels, leading to the deposition of urate crystals in the joints, causing inflammation, pain, and swelling.
What is the most common joint affected by gout?
The base of the big toe (metatarsophalangeal joint, MTP joint).
What are gouty tophi?
Subcutaneous deposits of uric acid crystals, often seen on the hands, elbows, and ears.
What are the key risk factors for developing gout?
- Male
- Family history
- Obesity
- High purine diet (meat, seafood)
- Alcohol
- Diuretics
- Cardiovascular disease
- Kidney disease
What is the critical differential diagnosis for an acute hot, swollen, and painful joint?
Septic arthritis, which must be excluded through joint aspiration and appropriate management.
What is the diagnostic test for gout?
Joint aspiration showing monosodium urate crystals that are needle-shaped and negatively birefringent under polarised light. Blood tests also show a raised serum urate level.
What does an X-ray of a joint affected by gout typically show?
- Maintained joint space (no loss of joint space)
- Lytic lesions in the bone
- Punched-out erosions
- Erosions with sclerotic borders and overhanging edges
What is the first-line treatment for acute gout flares?
NSAIDs (e.g., naproxen), co-prescribed with a proton pump inhibitor for gastroprotection.
What are the second and third-line treatments for acute gout flares?
- Second-line: Colchicine
- Third-line: Oral steroids (e.g., prednisolone)
Why is colchicine used in gout management, and what are its side effects?
Colchicine is used in patients who cannot take NSAIDs, such as those with renal impairment or heart disease. Side effects include abdominal symptoms, diarrhoea, and potential toxicity at high doses.
What are the prophylactic treatments for gout?
Xanthine oxidase inhibitors (e.g., allopurinol or febuxostat) to lower uric acid levels and prevent future attacks.
What lifestyle changes can reduce the risk of gout?
- Lose weight
- Stay hydrated
- Minimise alcohol consumption
- Avoid purine-rich foods (e.g., meat, seafood)
When is prophylaxis with xanthine oxidase inhibitors started in gout treatment?
Prophylaxis is started weeks after the acute attack has resolved. During the initial period, NSAIDs or colchicine may be used to prevent attacks.
