Gout

Question 1

Who does gout effect?

Answer 1

-1-2 in every 100 of the uk population affected by gout.
-affects men more than women. (10:1)
-

Question 2

Why is the prevalence of gout increasing in elderly women?

Answer 2

Increased use of diuretics in elderly women. The use of loop and thiazide diuretics leads to decreased excretion of uric acid —-> gout.

Question 3

Who is most affected by chronic polyarticular gout?

Answer 3

chronic polyarticular gout is unusual except in elderly on diuretics or in renal failure

Question 4

what is the typical presentation of gout?

Answer 4

• middle aged man
• sudden pain
• swelling and redness of great toe MTP joint
• usually after too much food / alcohol / dehydration.
• usually resolves in a week

Question 5

What are the risk factors for increased serum uric acid levelsʔ

Answer 5

• age
• obesity
• high protein diet
• high alcohol
• high fructose intake
• diabetes mellitus
• ischaemic heart disease
• hypertension
• family history
• CKD

Question 6

What causes impaired excretion of uric acidʔ

Answer 6

• chronic renal disease
• drug therapy (thiazide diruetics, low dose aspirin)
• ʜypertension
• ʟead toxicity
• Primary hyperparathyroidism
• hypothyroidism
• lactic acidaemia

Question 7

Polarized light microscopy of synovial fluid is one of the invx done for gout. What would it show to confirm the diagnosisʔ

Answer 7

negatively refringent urate crystals in the synovial fluid.

Question 8

What investigations are done for goutʔ

Answer 8

• Joint fluid microscopy (shows refringent urate crystals in synovial fluid)
• Serum uric acid (usually >600mol/l, but falls immediately after attack so may be falsely low.)
• Serum urea and creatinine - show signs of renal impairment which may cause decreased uric acid excretion.

Question 9

What is the treatment for goutʔ

Answer 9

1) ɴSɪADs (painkillers) in high does to reduce pain and swelling.

(Oʀ
use colchicine f ɢɪ ulcers ect.)

Steroids to reduce inflam

rest and elevate joint

Question 10

ʜow is gout preventedʔ

Answer 10

• lose weight
• avoid prolonged fasts, alcohol excess, red meat, low dose aspirin.
• AʟʟOPUʀɪɴOʟ (blocks the enzyme that converts xanthine into uric acid —> lowers serum uric acid)

Oʀ Febuxostat

Question 11

What is the differential diagnosis of gout attackʔ

Answer 11

-septic arthritis

Question 12

What does the gout affected joint look likeʔ

Answer 12

• severe pain in one or more joints
• the joint feeling hot and very tender
• swelling in and around the affected joint
• red, shiny skin over the affected joint
• TOPʜɪ