Gout Flashcards
What is gout?
Gout is a syndrome characterised by: hyperuricaemia and deposition of urate crystals causing attacks of acute inflammatory arthritis; tophi around the joints and possible joint destruction; renal glomerular, tubular, and interstitial disease; and uric acid urolithiasis. The disease most commonly affects the first toe (podagra), foot, ankle, knee, fingers, wrist, and elbow; however, it can affect any joint.
Where does gout commonly affect?
The disease most commonly affects the first toe (podagra), foot, ankle, knee, fingers, wrist, and elbow; however, it can affect any joint.
What are the risk factors for gout?
- Older age
- Male sex
- Menopausal state
- Consumption of meat, seafood and alcohol
- Use of diuretics
- Use of ciclosporin or tacrolimus
- Use of aspirin
What are the symptoms of gout?
- Rapid onset severe pain
- Joint stiffness
- Tenderness
What are the signs of gout?
- Foot joint distribution
- Few affected joints
- Swelling and joint effusion
- Tophi
- Rubor
- Calor
Briefly describe tophi
- Deposition of urate crystals in tissue, including bone and soft tissue.
- Manifests as hard painless nodules that may appear yellow and chalky if close to the surface of the skin.
What is shown in the picture?
Tophi
What investigations should be ordered for gout?
- Arthocentesis with synovial fluid analysis
- Serum uric acid level
- Ultrasound
Why investigate using arthrocentesis with synovial fluid analysis? And what may this show?
- WBC count increased; strongly negative birefringent needle-shaped crystals under polarised light.
- Provides definitive diagnosis. Excludes septic arthritis and differentiates gout from pseudogout (calcium pyrophosphate deposition disease).
Why investigate serum uric acid level? And what may this show?
- Increased serum uric acid level.
- Gout can develop with levels lower than the upper limit of normal values. Should be obtained at least 2 weeks after the attack resolves, as it may be falsely low or normal during the attack.
Why investigate using ultrasound? And what may this show?
- Erosions, tophi, double contour line.
What is the goal in management of gout?
The short-term treatment goal for acute gout is rapid resolution of pain and preservation of function. Long-term goals are to prevent recurrent attacks and chronic joint destruction. The earlier treatment is initiated, the better the clinical response.
Briefly describe the treatment of acute gout
- NSAIDs such as naproxen or ibeuprofen are first-line therapy if no contraindications exist. NSAIDs halt the inflammatory cascade of acute gout if they are started early.
- A corticosteroid, such as prednisolone, may be considered if NSAIDs are contraindicated. Corticosteroids can be given either as an intra-articular injection for monoarticular acute gout or parenterally for oligoarticular or polyarticular acute gout.
Briefly describe the treatment of chronic gout
- Urate lowering drugs such as allopurinol and febuxostat.
- Pharmacological anti-inflammatory prophylaxis (e.g., NSAID) is recommended for all gout patients during the initiation and titration of a urate-lowering drug. Anti-inflammatory prophylaxis should be continued for 3 to 12 months after reaching the target level of uric acid.
