Gout

Question 1

description of gout

Answer 1

monoarthropathy caused by deposition of monosodium urate crystals in hyperuricaemia

Question 2

risk factors for hyperuricaemia

Answer 2

male
CKD
diuretics
obesity
purine rich diet - alcohol, meat, seafood

Question 3

how does the joint present in gout?

Answer 3

tender, erythematous, swollen monoarthritis
1st MTP common
pain worse at night
lasts about 2 weeks

Question 4

other features of hyperuricaemia

Answer 4

gouty tophi

renal stones

Question 5

gout - investigations + reasons for requesting

Answer 5

gold standard - needle aspiration of synovial fluid: polarising microscopy (pseudo vs gout) + microbiology (rule out septic arthritis)
bloods - uric acid (may be high)
xray

Question 6

what can a gouty/pseudogouty joint show on needle aspiration?

Answer 6

polarising microscopy:
gout - negatively bifringent needle shaped crystals
pseudogout - positively bifringent rhomboid shaped crystals

Question 7

management of gout: lifestyle

Answer 7

keep hydrated
avoid purine rich diet - seafood, alcohol, meat
lose weight
avoid fasting

Question 8

management of gout: medication review

Answer 8

thiazides + loop diuretics can trigger gout

Question 9

acute management of gout

Answer 9

NSAIDs or colchicine

Question 10

prevention of gout

Answer 10

allopurinol - can trigger attack so wait 2 weeks after attack + offer colchicine/NSAID cover for first 1-3mo

Question 11

gout on xray

Answer 11

soft tissue swelling around 1 joint
erosions
sclerosis
peri-articular tophi - punched out lesions in bone

NO loss of joint space