Gout Flashcards
What is it
Inflammatory crystal monoarthropathy caused by the deposition of urate crystals
These monosodium urate crystas often precipitate in the metatarsophalangeal joint.
Gout involving the big toe is known as a podagra
Causes of gout
Many causes - essentially anything that increases urate levels may be the underlying cause. Examples include: Horrific DELAY: Hyperuricaemia, Hereditary Diuretics (thiazides) Ethanol Leukemia ranAl impairment associted with Lesch-NYan syndrome
Signs and symptoms of gout
Calor, dolor, rubor and tumour (heat, apin, redness and swelling) of the affected joint, which is usually the MTPJ in 50% of patients
Tophi (urate deposits) may present on tendon surfaces e.g. the elbow or visible on the ear
Patients may have symptoms of renal calculi
Investigations
Bloods - serum urate levels; FBC; WCC; U and Es; Creatinine; ESR; CRP
GFR - assesses kidney function
Synovial fluid analysis - positive if birefringent monosodium urate crystals are seen
Complications
Joint damage
Renal calculi
Tophi formation
Differences between gout and psuedogout: joints affected
Pseudogout - larger proximal
Gout - classically 1st MTPJ
Differences between gout and psuedogout: crystal type
Pseudogout - Calcium pyrophosphate crystals
Gout - Sodium urate crystals
Differences between gout and psuedogout: crystal shape
Pseudogout - Rhomboid
Gout - Needle
Differences between gout and psuedogout: light microscopy
Pseudogout - Negative birefringence
Gout - Strongly positive birefringence
Conservative treatment of gout
Patient education
Lifestyle advice e.g. encourage alcohol reduction and a low purine diet
Review medications that the patient is taking and stop causative agents e.g. thiazide diuretics, if possible
Medical treatment - acute gout
Analgesia
Colchicine and steroids
Medical treatment - chronic gout
Analgesia
Allopurinol
Febuxostat may be used if allopurinol is not tolerated by the patient
