Gout****

Question 1

Pathophysiology:

What electrolyte is raised which leads to this?

What forms within or around the joint itself?

Answer 1

Urate - hyperuricaemia

Monosodium urate crystal deposits in or around the joints

Question 2

Presentation:

Where does it usually occur?

Does it usually present as one or multiple joints?

Symptoms? - 5

Answer 2

MTP - metatarsophalangeal joint of the big toe

One - monoarthritis

Hot 
Red
Swollen 
Pain
May be immobile

Question 3

Presentation:

Hard white lumps (crystals) can form at the peripheries (e.g. fingers, toes, ears, tendons) in chronic disease. What is this called?

What may it form in the kidneys?

Answer 3

Tophi

Kidney stones or interstitial nephritis

Question 4

What must be ruled out when someone presents acutely with this?

Answer 4

Septic arthritis

Question 5

Risk factors:

Being older is a risk factor!!!

What sex is more likely to have this?

What lifestyle choices may cause it?

What drugs can cause this?

What diseases could increase the risk?

Answer 5

Men

Alcohol
Raised dietary purines - e.g. red meat

Diuretics
Cytotoxics

DM
HTN
CKD

Question 6

Investigations:

What needs to be done for a final diagnosis?

What needs to be measured in the blood?

XR - only soft tissue swelling is seen. What may be seen later on?

What chronic diseases can be screened for?

Answer 6

Joint aspiration - you see needle-shaped urate crystals

Serum urate - it can be normal - more reliable 4 wks after an attack

Punched out periarticular erosions

DM
Hyperlipidaemia

Question 7

Acute Management:

What pain med needs to be prescribed at a high dose?

What is an alternative to above if CI? - Col….

Steroids may also be prescribed (PO/IM/Intraarticular)

What can the patient do to relieve pain?

Answer 7

NSAIDs

Colchicine

Rest and elevate the joint
Ice packs

Question 8

Long term Prophylaxis:

Allopurinol:

• What is it?
• When is it needed? - 3
• Why must you start it 2 wks after an attack?
• Should it be continued during an attack for patients already on it?

Second-line is Febuxostat

What lifestyle changes can be made?

Answer 8

Xanthine-oxidase inhibitor

Recurrent attacks
Tophi
Renal stones

As it may trigger an attack or make the current one worse

Yes, continue it

Lose weight and reduce dietary purines

Question 9

Allopurinol:

Xanthine-oxidase inhibitor - How does it work?

Side effects - list some

Answer 9

Prevents conversion of xanthine into uric acid

N&V
Rash
Kidney Failure