Gout Flashcards
What causes gout?
Deposition of monosodium urate crystals in and near joints
Apart from the acute red swollen joint, what else might you see in gout?
Gouty tophi- on ears, tendons and joints
Renal disease may also occur due to precipitation in the renal tubules
What must you exclude in any acutely swollen joint? How is this done?
Must exclude septic arthritis- this is done by aspirating and sending for MC+S
If gout or pseudogout is suspected polarised light microscopy should be done
What are some differentials for an acutely swollen joint?
Septic arthritis Reactive arthritis Gout Pseudogout RA Hemarthrosis- following trauma most often
What are some risk factors for gout?
Red meat Beer Shellfish Dehydration Xanthine oxidase mutation Reduced renal function (reduced clearance) Tumour lysis syndrome Diuretics Antihypertensives
What diseases is gout associated with and should also be screened for in a patient presenting with gout?
CVD
DM
Renal disease
Check lipids, cholesterol, HBa1c, smoking status, Urine dip/ A:Cr
How do you investigate for gout?
Aspirate the joint and send for polarised light microscopy- Gout shows negatively birefringent crystals, Pseudogout (due to calcium pyrophosphate) shows positively birefringent crystals
Bloods- Urate, Calcium, Phosphate, eGFR, Creatinine,
What is the treatment of gout?
Acutely-
NSAIDs for analgesia or if CI use Colchicine e.g. Naproxen. Steroids PO or in the joint, RICE.
Post Acute Episode= Prevention
Allopurinol
Lifestyle change- weight loss, dietary change, exercise, stay hydrated.
When should allopurinol be started for prevention of gout?
Should be offered to all patients after their first attack of gout
Particularly if more than 1 attack in 12 months, presence of tophi, renal disease (reduced clearance), uric acid renal stones, diuretic use
What medicine is used for the prevention of gout?
Allopurinol is first line- normally start two weeks after acute attack
Note- if someone has an acute attack you do not need to stop the allopurinol therapy
What is the starting dose of allopurinol?
100mg OD and titrate up
What is the target for serum uric acid in gout?
Less than 0.3mmol/L
What is febexostat?
Xanthine oxidase inhibitor
Can be used 2nd line to allopurinol or if allopurinol is contraindicated
What are some side effects of allopurinol?
Rash
Fever
Decreased white cell count
What lifestyle modifications should you recommend to a patient with gout?
Reduce alcohol intake Reduce red meat Reduce shellfish Health balanced diet Drink lots of water Exercise Do you want to stop smoking
