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Rheumatology > Gout > Flashcards

Gout Flashcards

1
Q

What is Gout?

A

Crystal arthropathy associated with chronically high blood uric acid levels

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2
Q

What are the common joints affected by gout?

A
  • MTPJ of big toe (most common)
    • gout crystals heavy > drag down by gravity
  • Ankle
  • Foot
  • Small joints of hand
  • wrist
  • elbow
  • knee
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3
Q

What is Gouty tophi?

A
  • subcutaneous deposits of uric acid
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4
Q

Where does gouty tophi typically affect?

A
  • hands
  • elbows ears
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5
Q

What are the differentials for gout?

A
  • Septic arthritis - exclude this
  • reactive arthritis
  • haemarthrosis
  • calcium pyrophosphate deposition (CPPD)
  • palindromic RA
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6
Q

What are the causes of gout?

A
  • Underexcretion of uric acid by kidney
    • idiopathic
    • renal failure
    • thiazide, aspirin
  • Over production of purines
    • high purine diet (shellfish, meat, anchovies)
  • Genetic predisposition
  • Chemo/radiotherapy
  • Lesch Nyhan Syndrome
  • Phosphoribosyl Pyrophosphate Synthase Excess
  • Von Gierke Disease
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7
Q

What are the RF for Gout?

A
  • Male
  • Obesity
  • High purine diet (e.g. meat and seafood)
  • DM
  • Alcohol
  • Diuretics
  • Existing cardiovascular or kidney disease
  • Family history
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8
Q

What is the Px of Gout?

A
  1. Plasma saturated with urate acid
  2. urate acid react c sodium > form monosodium urate crystals
  3. urate crystals deposit in soft tissues and joints
  4. tissue damage > gout attack triggered
  5. influx of neutrophils into joints
  6. joint swelling > cleared spotaeneously in 10 days
  7. persistent gout attacks > chronic gout
  8. permanent deposition of urate cyrstals around joint
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9
Q

What disease are associated c gout?

A
  • CVS diseases
  • HTN
  • DM
  • CRF
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10
Q

How would you Ix for gout?

A
  • Serum urate: high
    • can be normal in chronic haemolytic anaemia
  • Fluid aspiration
  • Joint xray
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11
Q

What are the features of fluid aspiration of gout?

A
  • Needle shaped crystals
  • Negative birefringent of polarised light
  • Monosodium urate crystals

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12
Q

What are the xray features of gout?

A
  • soft tissue swelling (early stage)
  • Lytic lesions in the bone
  • Punched out erosions
  • Erosions can have sclerotic borders with overhanging edges
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13
Q

How would you Mx gout during acute flare?

A
  • NSAID or Colchicine - first line
    • PPI for gastro protection
  • Steroids (15mg Pred/day) - if NSAID or Colchicine contraindicated
    • for renal impaired
  • Ice packs
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14
Q

What are the prophylaxis management of gout?

A
  • Allopurionol
    • dec uric acid levels
  • febuxostat - if allopurinol contraindicated
  • Lifestyle changes
    • reduce alcohol intake and avoid during an acute attack
    • lose weight if obese
    • avoid food high in purines
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15
Q

What is MOA of allopurinol? When can you not initiate Allopurinol?

A
  • xanthine oxidase inhibitor
  • before acute attack settles. only when allopurinol started then it can be continued during an acute attack
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16
Q

What drug class is Colchicine?

and what is the MOA?

A
  • anti-gout agents
  • tubulin disruption > down regulation of inflammatory patyhway
17
Q

What are the differentials for gout?

A
  • Septic arthritis
  • Olecranon bursitis
  • Milwaukee shoulder
  • Chondrocalcinosis
  • Pseudogout
  • Arthritis
  • Haemochromatosis
18
Q

How do you tell the difference between gout and pseudogout on xray?

A
  • Chondrocalcinosis
19
Q

What is pseudogout?

A
  • microcrystal synovitis caused by the deposition of calcium pyrophosphate dihydrate crystals in the synovium
20
Q

What are the RF of pseudogout?

A
  • Increasing age
  • If pseudogout develop younger (<60)
    • haemochromatosis
    • hyperparathyroidism
    • low magnesium, low phosphate
    • acromegaly, Wilson’s disease
21
Q

What are the features of pseudogout?

A
  • knee, wrist and shoulders most commonly affected
  • joint aspiration: weakly-positively birefringent rhomboid-shaped crystals
  • x-ray: chondrocalcinosis
  • in the knee this can be seen as linear calcifications of the meniscus and articular cartilage
22
Q

How would you Mx pseudogout?

A
  • aspiration of joint fluid, to exclude septic arthritis
  • NSAIDs or intra-articular, intra-muscular or oral steroids as for gout

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