Gout Flashcards

1
Q

What is the definition of gout?

A

Defect in metabolism of uric acid causing arthritis

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2
Q

How common is gout?

A

Prevalence of gout is 1.4%

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3
Q

What is the pathophysiology of gout?

A
  • > 50% occur at the metatarsophalangeal joint of the big toe
  • Deposition of precipitated monosodium urate crystals in and near joints – less soluble under acid and low temperatures
  • Due to too much uric acid/urate in the blood
  • Urate deposits = tophi in pinna (outside the ear), tendons and joints
  • Renal disease (stones and interstitial nephritis) may also occur
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4
Q

What is the aetiology/risk factors for gout?

A
  • Men
  • Trauma
  • Surgery
  • Starvation
  • Infection
  • Diuretics
  • Hereditary
  • ↑ diet purines – meats mainly
  • Alcohol
  • Leukaemia
  • CV disease
  • Hypertension
  • Diabetes
  • Chronic renal failure
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5
Q

What are the signs/symptoms of gout?

A
  • Swollen
  • Tender
  • Erythematous
  • Fever
  • Malaise
  • Difficulty using the affected joints
  • Pressure ↑ pain exponentially
  • Maximum pain after before 24 hours
  • Tophi – draining or chalk like subcutaneous nodule under skin
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6
Q

What diseases does gout present similarly to?

A
  • Septic arthritis
  • Haemarthrosis
  • CPPD
  • Palindromic RA
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7
Q

What investigations would be needed to diagnose gout?

A
  • ↑ plasma/serum urate
  • Polarised light microscopy of synovial fluid – shows urate crystals
  • 24h urine sample
  • Fasting glucose
  • Fasting lipids
  • X-Ray: soft tissue swelling initially the well punched out erosions seen in bone
  • US: double contour sign
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8
Q

What are the pharmacological treatments for gout?

A
  • High dose NSAID
  • Colchicine
  • Allopurinol – prevention
  • Febuxostat – prevention
  • Steroids – oral/IM/intra-articular
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9
Q

What are the non pharmacological treatments for gout?

A
  • Rest and elevate the affected joint – e.g. bed cage to keep foot elevated at night
  • Ice packs
  • Lose weight
  • Avoid prolonged fasts
  • Reduce alcohol consumption
  • Reduce purine rich meats
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