Gout

Question 1

Why do monosodium urate crystals precipitate in the joints and kidney tubules?

Answer 1

Slow blood flow

Question 2

Purine are converted to what when broken down?

When will hyperuricaemia occur?

How do MSU form?

Answer 2

Uric acid

When uric acid levels exceed the level of thei limited solubility

At physiological pH uric acid loses H+ and binds to Na+ ion instead

Question 3

Why can consuming excess shelffish or red meat lead to gout?

Why do high fructose corn syrup drinks lead to MSU crystal formation?

Two other risk factors for gout?

Answer 3

Purine rich foods leading to increased prune consumption

Increased production of purines.

Obesity, diabetes, chemotherapy

Question 4

Name two medications increasing risk?

Answer 4

Thiazide

Aspirin

Question 5

What is podagra?

Answer 5

First metatarsal joint of big toe affected

Question 6

Treatment?

Answer 6

NSAIDs 
Colchicine 
Diet modification 
Allopurinol 
Probenecid (increase excretion in kidneys)

Question 7

Chronic gout manifestations?

Answer 7

Tophi

Urate nephropathy

Question 8

What crystals are deposited in psuedogout?

RFs

Answer 8

Calcium pyrophosphate dehydrate crystals

Increased age (main one)
Hyperparathyroidism
Hypothyroidism

Question 9

Compare psuedogout to gout?

Diagnosis?

Answer 9

Psuedogout - polyarticular
Less painful
Slower onset
Self limiting

Arthrocentesis - CPPD crystals
X-ray - chondrocalcinosis

Question 10

Tx of psuedogout

Answer 10

Arthrocentesis
Rest
NSAIDs
Steroids to relive inflammation

Question 11

What imaging method is used to visualise gout?

What will you see in gout vs psuedogout?

Answer 11

Polarised light microscopy

Gout - negatively bifringement crystals - yellow when parallel to plane of light

Psuedogout - weakly positive bifringence