Gout Flashcards

1
Q

presentation

A

acute monoarthropathy with severe joint inflammation

>50% at MTP of the big toe

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2
Q

pathophysiology

A

deposition of monosodium urate crystals in and near the joints
can be precipitated by trauma, surgery, starvation, infection or diuretics
ass. w/ raised plasma urate
in the long term, urate deposits (= tophi, eg in pinna, joints, tendons) and renal disease (stones, interstitial nephritis) may occur

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3
Q

DDx

A

exclude septic arthritis
haemarthrosis
pseudogout (calcium pyrophosphate deposition)
RA

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4
Q

causes

A
hereditary
increased dietary purines
alcohol excess
diuretics
leukaemia
cytotoxics (tumour lysis)
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5
Q

associations

A

CVD
HTN
DM
chronic renal failure

gout is a marker for these, so seek and out treat if needed

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6
Q

investigations

A

polarized light microscopy of synovial fluid shows NEGATIVELY BIREFRINGENT urate crystals
serum urate is usually raised but may be normal
radiographs show only tissue swelling in the early stages
later, well defined, punched out erosions seen in juxta-articular bone
no sclerotic reaction
joint spaces preserved until late

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7
Q

Tx

A

high dose NSAIDs or coxib (eg etoricoxib)
Sx should subside in 3-5d
rest and elevation

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8
Q

prevention

A

lose weight
avoid prolonged fasts, purine rich meats and low dose aspirin, which raise serum urate
aim to reduce joint damage and reduce number of attacks
use allopurinol

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9
Q

calcium pyrophosphate deposition (CPPD)

A

umbrella term for the following:
acute CPP crystal arthritis (pseudogout) - like gout
chronic CPPD - inflammatory RA-like polyarthritis and synovitis
osteoarthritis with CPPD - OA with superimposed CPPD attacks

risk factors:
old age, hyperaldosteronism, haemochromatosis, hypophosphataemia

tests:
POSITIVELY BIREFRINGENT crystals

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10
Q

management CPPD

A

acute:
ice packs, rest, aspiration, intra-articular steroids
NSAIDs +/- colchicine
methotrexate and hydroxychloroquine also have a role in chronic CPPD

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