Gout Flashcards
Gout pathology
It is the deposition of monosodium urate monohydrate crystals at synovial joints
Epidmiology of Gout
prevalence is 1-2%
M4:1F
Gout is becoming more common
Risk factors of gout
Trauma
Surgery
Starvation
Infection
Diuretics (thiazide)
Common joints to be affected with gout
metatarsophalangeal joint of the big toe
other
knee ankle foot
elbow wrist or small joints of hands
It can be polyarticular
Differential diagnosis of gout
Exclude septic arthritis
cellulits
reactive arthritis
Causes of gout
Hereditary
Increased dietary purines - in protein
Alcohol excess
Diuretics
Leukemia
Cytotoxic
Which conditions are associated with gout
CVS disease
HTN
DM
Chronic renal failure
Investigations for gout
Microscopy of synovial fluids
Serum urate - maybe normal, usually raised
Radiograph shows soft tissue swelling in early stages
Joint spaces are reserved until late
Prevention of Gout
Lose weight
Avoid:
prolonged fasts
Alcohol excess
Purine rich meats
low dose aspirin (increases serum urate)
Tell me about using allopurinol in gout
Only start after 3 weeks of acute gout because it may trigger gout
Cover with regular NSAIDs
Avoid stopping allopurinol in acute attacks if allopurnol was already used before attack
symptoms of acute gout
It presents as rapid onset of severe pain
signs of acute gout
On examination
marked synovitis with swelling
red shiny skin
extreme tenderness
Periarticular swelling and fever may be present
What happens after the first acute attack of gout
Many patients develop another episode of gout within a year
Medicine management of acute gout
NSAIDs - symptoms should subside within 3-5 days
Colchicine used when NSAIDs contraindicated but works slower
Joint aspiration and intra-articular corticosteroid injections are more effective in severe cases
Conservative management of acute gout
Ice packs
