Gout Flashcards

1
Q

Definition

A

Inflammatory response to the deposition of monosodium urate crystals in joints

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2
Q

Clinical features

A
  • acute monoarthropathy of distal joint “podagra”
  • sudden onset
  • Red, hot, swollen, tender joint
  • systemic symptoms
  • Prodromal symptoms
  • very painful, joint inflammation
  • affects 1st MTP Bjoint of foot BIG TOE - “podagra”
  • can affect any joint
  • elderly
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3
Q

Causes

A

Primary

  • hyperuricaemia due to genetic predisposition

Scondary

  • PRCV- too much nucelic acid/purine Increase urate
  • leukaemia - tbx by chemo
  • CKD - cant secrete uric acid
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4
Q

pathogeneiss

A

excess uric acid (breakdown of purine), leads to deposition of urate in joints and soft tissues (tophi)

  • acute gout - precipitation in joints stimulate acute inflamm response
  • Chronic gout - tophi formation (subcutaenous nodules)
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5
Q

Diagnosis

A
  • Blood tests
    • CRP/ESR
    • FBC
    • SUA levels
  • Joint Aspirate
    • Polarised light -needle shaped and negatively birefringent
    • Gram stain and culture
  • X-rays - only soft tissue swelling in early stages. Later well defined punched out lesions
  • Measurement of cardiovascular risk
  • Primary versus secondary cause
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6
Q

Management of acute gout

A

Bed rest and cold packs

Analgesia

  • NSAIDs - high dose rapidly reduces pain
  • COX-2 Inhibitor

Colchicine

Steroids - intra-articular, oral

Interleukin-1 Antagonist

If reccurent - allopurinol - xanthine oxidase (stops [rpduction of uric acid)

urisocuric agent - increased secrretion of uric acid into urine

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7
Q

Management of chronic gout

A

Lifestyle modification/avoidance of risk factors

  • weight loss
  • restrict alcohol
  • dietary modification
  • avoid certain medications

Uric acid lowering therapy should be initiated in following circumstances:

  • recurrent attacks
  • tophi
  • chronic gouty arthritis
  • renal disease
  • urate lithiasis
  • SUA >0.54
  • Diuretic use cannot be avoided
  • failure of lifestyle modification to lower SUA
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8
Q

Uric acid lowering therapy

A

Three methods:

  • inhibit produciton (allopurinol or febuxostat)
  • increase breakdown (pegloticas)
  • increase excretion
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9
Q

Allopurinol

A
  • Xanthine oxidase inhibiter
  • check renal function prior to commencing
  • usually start at 100mg and titrate up to maximum dose of 900mg daily
  • Colchicine or NSAID cover
  • check SUA monthly and maintain <0.36 mmol/l
  • Side effects - mild rash, hypersensitivity reaction, drug interactions
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10
Q

Febuxostat

A
  • For those unable to tolerate allopurinol
  • Non-purine xanthine oxidase inhibitor
  • Start at 80mg/day
  • Titrate to 120mg/day
  • Maintain SUA <0.36 mmol/L
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11
Q

Prevention of attacks

A
  • lose weight
  • avoid prolonged fasts, alcohol excess, purine rich meats and low dose aspirin

Prophylaxis

  • Start if >1 attack in 12 months, tophi or renal stones
  • the aim is to decrease attacks and prevent damage cause by crystal deposition
  • Use allopurinol and increase every 2 weeks
  • Introduction of allopurinol may trigger an attack so wait until 3 weeks after an acute episode and cover with regular NSAIDs or colchicine
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