Gout Flashcards
How does gout typically present?
Acute mono-arthropathy
Severe joint inflammation
Where do the majority of gout presentations occur?
Metatarsophalangeal joint of the big toe (podagra)
What causes gout?
Deposition of mono-sodium urate crystals in and near joints
What may precipitate attacks of gout?
Trauma, surgery, infection, diuretics, starvation
What may be raised in blood tests of someone with gout?
Plasma urate
What may occur in the long term sufferers of gout?
Urate deposits = tophi (Pinna, tendons, joints) Renal disease (stones, interstitial nephritis)
Which gender is more likely to have gout?
M 4:1
Differential diagnosis for gout?
Septic arthritis, RA, haemarthrosis, CPPD
What are the risk factors for gout?
Reduced urate excretion: elderly, men, post menopausal women, impaired renal function, hypertension, metabolic syndrome, antihypertensives, diuretics, aspirin
Excess urate production: dietary (alcohol, sweeteners,re meat, seafood), genetic disorders, lymph and myeloproliferative disorders, psoriasis
Causes of gout
Hereditary
Drugs: diuretics, NSAIDs, cutotoxics, pyrazinamide
Decreased excretion: renal impairment
Increased cell turnover: lymphoma, leukaemia, psoriasis, homeless
EtOH excess
Purine rich foods: beef, pork, lamb, seafood
What are some associations with gout?
HTN
IHD
Metabolic syndrome
What investigations can be performed to investigate for gout?
Polarised light microscopy of synovial fluid
Measure serum urate
Xray changes (late)
What would you expect to see under polarised light microscopy in gout?
Negative birefringent needle shaped crystals
What would you expect the serum rate of someone with gout to be
Raised but may be normal
What Xray changes may you see in a person with gout?
Punched out erosions in junta articular bone
Decreased joint space is a very late change
What is the treatment of acute gout?
High dose NSAIDs
What treatment should be used for gout if NSAIDs are contraindicated?
Colchicine
What is the disadvantage of using colchicine to treat gout as compared to NSAIDs?
Colchicine is slower to work
What are some conservative treatments for gout?
Rest and elevate
Ice pack
Bed cage
How should gout be treated in patients with gout?
NSAIDs and colchicine are contraindicated
Treat with steroids
What can be done to prevent gout conservatively?
Lose weight, avoid prolonged fasts, decrease alcohol, less purine rich foods, low dose aspirin
What treatments can be used to prevent gout?
Xanthine oxidase inhibitors (less rate production) such as allopurinol when there are recurrent attacks or if there are top
Uricosuric drugs increase rate excretion
