Gout Flashcards
What facts should you elicit from the history?
- Pain at base of big toe
- Worse at night
- Associated redness
- Low grade fever (systemic infection)
What examination findings should you note?
Chronic tophaceous deposit with asymmetrical joint involvement
Tell examiner you would like to examine
- Helices of ears
- Elbow for olecranon bursae
- Achilles tendons for tophi
- Feet or hands
What is the basic pathophysiology of gout?
Disorder of purine metabolism causing hyperuricaemia due to either
Overproduction (75%)
or
Underexcretion (25%)
of uric acid
How would you treat an ACUTE ATTACK of gout?
NSAIDs such as diclofenac, etoricoxib, indomethacin
Corticosteroids
What factors may precipitate acute gouty arthritis?
Drugs High alcohol consumption Dehydration Surgery Foods high in purines
What drugs may precipitate acute gouty arthritis?
Diuretics (forusemide)
Aspirin
What foods are high in purines and can precipitate acute gouty arthritis?
Liver, kidney, sardines, sweetbreads
What circumstances would prompt you to treat hyperuricaemia?
- Frequent attacks of acute arthritis
- Renal damage
- Consistently raised serum uric acid levels
What treatment should be tried and tested before attempting to lower serum uric acid levels?
Colchicine
What is the drug of choice for lowering serum uric acid levels?
Allopurinol (xanthine oxidase inhibitor)
What medication may be used for acute gouty arthritis attacks (at least 3 in previous 12 months) that has responded poorly to NSAIDs or Colchicine, or intolerant of them?
Canakinumab
a recombinant monoclonal antibody
What are the diagnostic criteria for acute gout?
7 or more from the following
- > 1 attack of acute arthritis
- Maximum inflammation developed over 1 day
- Attack of monoarthritis
- Redness over joints
- 1st MTP joint painful and swollen
- Unilateral attack of 1st MTP joint
- Unilateral attack of tarsal joint
- Tophus (proven or suspected)
- Hyperuricaemia
- Asymmetrical swelling, within a joint on XR
- Subcortical cysts without erosions on XR
- Monosodium urate crystals in joint fluid during attack
- Culture of joint fluid negative during attack
What drug would you use if the patient was allergic to allopurinol?
Febuxostat
Sulfinpyrazone
How would you determine whether hyperuricaemia is due to overproduction or underexcretion?
Overproduction = 24 hour urinary uric acid level >750mg
What is pseudogout?
Acute arthritis from release of calcium crystals (deposited in bone and cartilage) into the synovial fluid
