Gout Flashcards
How does gout occur?
Increased urate crystals
Phagocytosed by macrophages and produce pro-inflam cytokines
Difference between gout and pseudogout on joint aspiration under polarized light?
What kind of crystals are each?
Gout - rod/needle like crystals - URATE
Pseudogout - regular rhomboid shaped crystals - CALCIUM PYROPHOSPHATE
What is the other name for psuedogout?
CPPD
What is the difference in presentation between gout and psuedogout
Both present with inflammed joint
Psuedogout more likely to be larger joints (knee, ankle, wrist) than gout (big toe)
Psuedogout is also more likely to present in older patients
What is gouty tophi?
Where is it most common?
Gout in soft tissue - most commonly hand, elbow and ear
What treatment is used for acute flareup of gout?
What side effect does colchicine cause?
- NSAIDS
- Colchicine (if NSAIDS contradicted)
- Steroids
Dose-dependant diarrhoea
What treatment is used as prophylaxis of gout?
What is the MoA?
How must it be perscribed?
Allupurinol
Xanthane oxidase inhibitor - reduce uric acid
Start 2 weeks after acute attack - can then be continued through following acute attacks
Always cover with NSAIDS/colchicine for first 2-4 weeks or can reactivate acute gout
What lifestyle advice should be given to gout patients?
Reduce purine (seafood and meat) in diet Reduce alcohol
What is a gout patient’s target uric acid levels?
300-360 umol/l
Aspirated fluid showing “Negative birefringent of polarised light”
Aspirated fluid showing “Postitive birefringent of polarised light”
Gout
Pseudogout
What should always be excluded in ur DD before treating gout?
Septic arthritis
What is the most commonly affected joint in pseudogout?
Knee
Does gout or psuedogout usually present with an older patient?
Psuedogout
What is the diagnostic Xray sign of pseudogout?
Chondrocalcinosis
Hydroxyapatite crystals are found in what condition?
Milwaukee shoulder
