Gout Flashcards
In a 42 year old gentleman who presents with monoarticular arthritis of his right knee, what relevant questions do you need to ask him?
HPI Monoarticular, polyarticular, joints involved MCP for RA, 1st MTP for gout. Severity Swelling Pain history Associated symptoms Stiffness aggravating factors worse with walking with OA, worse with rest with inflammatory arthritis Systems review Rash in psoariatic arthrits Urethritis in gonnococal arthritis. Eye involvement in autoimmune causes Diarrhoea PR bleed in reactive arthritis fever
Past medical history Gout Trauma, fractures ACL tears Sporting injuries Drug use in septic arthritis immunosuppression
Medications
What relevant findings on examination are you looking for?
Joint swelling, tenderness, limited ROM, erythema Febrile Joints involved RA MCP, PIP, wrists. Gout knee, 1st MTP, wrist
Systemic fever
Extraarticular head to toe approach Anterior uveitis in spondylarthropathy Enthesisitis/dacytylitis erythema nodosum seen in reactive arthritisb stigmata of endocarditis gouty tophi
What investigations should you consider a patient with suspected Gout?
Joint aspiration - synovial flui MCS, cell count and differential and crystal analysis
WCC
CRP/ESR
Uric acids may be normal or elevated
Blood cultures
Xray if concerned about trauma or bony erosions.
Note differentiating septic arthritis and gout can be difficult
What is your treatment for acute gout?
NSAID indomethacin, naprosyn
Pred - 25mg daily, weaning dose for 2 weeks.
Colchicine 1mg stat, then 500microg 1 hour after that, then 50microf q6h max 6mg in 4 days.
What gout prevention can you do?
Weight loss
Allopurinol lowering to target may need 300mg daily. start at 100mg daily.
use concurrent colchicine 500microg BD until reach target.
Sugars, fructose
Saturated fats
Purines ie shellfish, pate, kidney.
Probenacid
What side effects of allopurinol do you need to be aware of?
Allopurinol hypersensitivity syndrome, steven johnson syndrome. risk factors include Han chinese ancestry HLA B5801
Rash
