Gout Flashcards
Define gout?
A disorder or uric acid metabolism causing recurrent bouts of acute arthritis caused by deposition of monosodium urate crystals in joints, and also soft tissues and kidneys
What is the main metabolic disturbance in gout?
Hyperuricaemia
What can gout be caused by?
Increased urate intake or production
Decreased renal excretion
What are the different types of increased urate intake or production?
Increased dietary intake
Increased nucleic acid turnover (e.g. lymphoma, leukaemia, psoriasis)
Increased synthesis of urate (e.g. Lesch-Nyhan syndrome)
What are the different types of decreased renal excretion?
Idiopathic
Drugs (e.g. ciclosporin, alcohol, loop diuretics)
Renal dysfunction
What is the epidemiology of gout?
10 x more common in MALES
Very rare pre-puberty
Rare in pre-menopausal women
More common in HIGHER social classes
What are the precipitating factors for an Acute Attack of gout?
Trauma Infection Alcohol Starvation Introduction or withdrawal of hypouricaemic agents
What are the symptoms of an Acute Attack of gout?
Sudden Excruciating monoarticular pain
Symptoms peak at 24 hrs
They resolve over 7-10 days
Sometimes, acute attacks can present with cellulitis, polyarticular or periarticular involvement
Attacks are often recurrent
Patients are symptom-free between attacks
What does the sudden excruciating monoarticular pain usually affect?
The metatarsophalangeal joint of the great toe (podagra)
What is the definition of Intercritical gout?
Asymptomatic period between acute attacks
What is the definition of Chronic Tophaceous gout?
Follow repeated acute attacks
What is the symptoms of Chronic Tophaceous gout?
Persistent low-grade fever
Polyarticular pain with painful tophi (urate deposits)
Best seen on tendons and the pinna of the ear
What are the other main symptoms of gout?
Symptoms of urate urolithiasis (renal calculi symptoms)
Why do we do Synovial Fluid Aspirate for gout?
Monosodium urate crystals will be seen
They are:
- Needle-shaped
- Negative birefringence under polarised light microscopy
Microscopy and culture will also be performed to exclude septic arthritis
What bloods do we do for gout?
FBC - raised WCC
U&Es
Raised urate
Raised CXR
