Gout

Question 1

What is gout

Answer 1

• Disorder of purine metaolism characterised by hyper-uricaemia + deposition URATE crystals in joints + other tissues e.g. connective tissue/urinary tract

(NB: gout + hyperuricaemia can happen separate from each other)

Question 2

What are the phases of gout

Answer 2

1. asymptomatic hyperuricaemia
2. acute attack followed by symptomless periods
3. chronic tophaceous gout –> nodules affecting joint

Question 3

How common is it

Answer 3

1.4% population

Question 4

Who gets it

Answer 4

Men 30-60years

M>F = 5:1

Question 5

What causes it

Answer 5

• Uric acid = end product of purine breakdown
• 2/3rd urate excreted by KIDNEYS and 1/3 by GI
• Renal impairment = 90% hyper-uricaemia
• ++ urate production = 10%
• Hereditary
• Increased dietary purines (red meat, seafood)
• Alcohol excess
• diuretics
• Leukaemia
• Cytotoxics (tumour lysis)

Question 6

What are some risk factors

Answer 6

• Alcohol
• Purine diet
• Drugs which raise plasma urate (aspirin, ciclosporin, diuretics, cytotoxic, tacrolimus)
• Lead exposure
• FHx
• Obesity
• HTN
• DM
• severe psoriasis
• Hyperlipidaemia

Question 7

What are the symptoms

Answer 7

• Acute pain in joint
• Swollen, erythematous –> reaches crescendo over 6-12hr period (CRYSTAL ARTHROPATHY)
• Max intensity = 24hr
• (fever + malaise)
• 70% in big toe

Question 8

What are the signs of gout

Answer 8

• Florid synovitis + swelling
• Extreme tenderness w. overlying erythema
• Arthritis - swelling, redness, warmth, pain on passive movement
• Tophi - firm white translucent nodules (takes 10yrs after 1st attack)
• Asymmetrical
• Extensor surfaces

Question 9

What are some DDx

Answer 9

• Septic arthritis
• Chronic tophaceous - rheumatoid arthritis, generalised nodal OA
• Pseudogout
• OA, psoriatic arthritis

Question 10

What investigations do you perform

Answer 10

• None needed
• Joint fluid microscopy + culture –> if septic arthritis suspect
• Serum uric acid + plasma urate measured 4-6weeks after acute attack to confirm
• Joint x-ray
• Renal functional tests

Question 11

What treatments would you give

Answer 11

• RICE
• NSAIDs
• Colchicine - particularly when NSAIDs poorly tolerated
• Allopurinol - reduce production of uric acid
• Corticosteroids
• Analgesia

Question 12

What are some of the complications

Answer 12

• May lead to hyperuricaemia-induced renal disease

- 10-25% people with gout have urinary stones