Gout

Question 1

What is gout?

Answer 1

Pain and swelling in the smaller joints due to deposition of monosodium urate crystals in and around the joints

Question 2

Aetiology of gout

Answer 2

Hereditary
Drugs: diuretics, NSAIDs, cytotoxics
Renal impariment
Conditions of increased cell turnover
Purine rich foods

Question 3

Epidemiology

Answer 3

4x more common in men

Almost never occurs in premenopausal women

Question 4

Which conditions is gout associated with?

Answer 4

HTN
IHD
Metabolic syndrome

Question 5

Investigations to consider in gout

Answer 5

Polarized light microscopy: shows -ve bifringent crytals
Serum urate: can be normal or raised
Radiographs: changes occur late - punched out erosions

Question 6

Most common site of gout

Answer 6

Podagra: great toe MTP
Then: ankle, foot, wrists, hand joints and elbow

Deposits can be found in the pinna and tendons: tophi

Question 7

Management of an acute episode of gout

Answer 7

High dose NSAID or COXIB
If contraindicated use colchicine
RICE the joint

Question 8

Preventative methods and treatments for gout

Answer 8

Conservative: lose weight fatty and control diet

Medical: Xanthine oxidase inhibitors (allopurinol)
-introduce with NSAID