Gout

Question 1

What is Gout? (2)

Answer 1

A form of inflammatory arthritis

Form of microcrystal synovitis caused by the deposition of monosodium urate monohydrate in the synovium.

Question 2

Causes/Risk factors? (8)

Answer 2

diuretics
alcohol XS
Dietary purines
chronic kidney disease
lead toxicity
myeloproliferative/lymphoproliferative disorder
cytotoxic drugs
severe psoriasis

Question 3

Presentation?

Answer 3

Pain (significant)
swelling
erythema

Question 4

Most common place it occurs in the body?

Answer 4

1st metatarsophalangeal (MTP) joint (50%) - podogra

Question 5

Radiological features of gout?

Answer 5

Joint effusion (early sign)
well-defined ‘punched-out’ erosions with sclerotic margins
eccentric erosions
no periarticular osteopaenia (in contrast to rheumatoid arthritis)
soft tissue tophi (deposit of uric acid crystals) may be seen

Question 6

Acute Mx?

Answer 6

NSAID
intra-articular steroid injection
colchicine
if patient is already taking allopurinol it should be continued (e.g. Lesch-Nyhan syndrome)

Question 7

Main side effect of colchicine?

Answer 7

Diarrhoea

Question 8

Indications for allopurinol? (5)

Answer 8

recurrent attacks
tophi
renal disease
uric acid renal stones
prophylaxis: if on cytotoxics or diuretics

Question 9

Lifestyle changes? (4)

Answer 9

reduce alcohol intake and avoid during an acute attack
lose weight if obese
avoid food high in purines e.g. Liver, kidneys, seafood, oily fish (mackerel, sardines) and yeast products
keep hydrated