Gout Flashcards
What is the pathophysiology of Gout?
Monosodium urate crystals deposited in and around joints causing erosion
What can cause an exacerbation of Gout?
Surgery
Diuretics - Thiazide
Infection
Fasting
What are some of the risk factors for Gout?
Male
Diet high in purine eg seafood, beef, pork
What are Tophi?
Monosodium urate crystals that have deposited in tendons
What is Podagra?
Gout in the metatarsal phalangeal joint of the great toe
How does Gout present?
Monoarthropothy
Acute
Asymmetrical
Severe joint inflammation and pain
What joints are commonly effected by Gout?
Ankle Foot Hand Wrist Knee Elbow
What renal disease can occur in Gout?
Radiolucent stones
Interstitial nephritis
What are some of the differentials for Gout?
Septic arthritis
Pseudogout
Haemarthrosis
What are some of the causes of Gout?
Hereditary
Drugs - NSAIDs, Thiazide diuretics, cytotoxics, pyrazinamide
Decreased excretion - Renal impairment
Increased cell turnover - Lymphoma, leukaemia, psoriasis
Ethanol excess
Purine rich foods - beef, pork, seafood
What diseases are associated with Gout?
Metabolic syndrome
IHD
HTN
What investigations can be done in a patient with suspected Gout?
Polarised light microscopy - negative needle shaped crystals = gout
Serum uragte levels (may be increased, may be normal)
X ray - changes occur late into disease
What changes are seen on X ray in a patient with Gout?
Occur late in disease
Punched-out erosions in juxta-articular bone
Decrease in joint space
What is the treatment for an acute attack of Gout?
NSAIDs - Diclofenac
Colchicine (If NSAIDs contraindicated eg PUD
Steroids (If in renal impairment as NSAIDs and Colchicine are contraindicated!)
What are the side effects of Colchicine?
Diarrhoea
How can you try to prevent Gout attacks?
Loose weight
Reduce alcohol intake
Adjust diet to have less Purine rich foods
Drugs if lifestyle adjustments aren’t reducing attacks
What drugs can be used to prevent Gout attacks?
Xanthine Oxidase Inhibitors (Allopurinol) Uricosuric drugs (Losartan) Recombinant urate oxidase (Rasburicase)
When do you use Allopurinol in the treatment of Gout?
If recurrent attacks, tophi or renal stones are present
When the patient is not having an acute attack
Give NSAIDs/Colchicine to cover for 3/12 with introducing Allopurinol as may cause an attack
What are the side effects of Allopurinol?
Rash
Fever
Decreases WCC if given with Azathioprine
What alternative drug can be given if a patient is allergic to Allopurinol?
Febuxostat (Xanthine Oxidase inhibitor)
