Gout Flashcards
What is gout?
Inflammatory disease where uric acid (urate) precipitates into urate crystals that deposit in a joint
Causes of hyperuricaemia
Increased production of uric acid (enzyme defect, increased purine consumption (red meat, seafood, alcohol, dairy), increase cell turnover (chemotherapy, radiation, psoriasis, myeloproliferative/lymphoproliferative disorders))
Reduced/impaired excretion of uric acid (more common)
(dehydration –> excessive alcohol intake, chronic renal impairment, volume depletion in heart failure, hypothyroidism, thiazide diuretics)
Presentation of acute attack of gout
Acute onset monoarthropathy (red, hot, swollen, tender, joint)
Commonly affected joints: first MTP, ankle, knee
Presentation of chronic gout
Occurs after many attacks
Asymmetrical polyarthritis
Tophi (deposits of uric acid)
Risk factors for gout
Older adults Males Obesity Rarely seen before the menopause Alcohol Drugs
Investigation for gout
RULE OUT SEPTIC ARTHRITIS Polarizing microscopy of aspirated fluid Serum uric acid: (usually raised, may be normal in an acute attack) ↑inflammatory markers XR
Results of polarizing microscopy of aspirated fluid in gout
Needle shaped, negatively birefringent monosodium urate crystals
XR findings in gout
Punched out erosions
Complications of gout
Renal disease
Destructive erosive arthritis
Treatment of an acute attack of gout
1st line = high dose NSAIDs
2nd line = colchicine
3rd line = steroids
Prophylaxis for gout
Allopurinol (urate lowering drug)
others: febuxostat, uricourics
Allopurinol should be started during an acute attack and then continued during other acute attacks (true/false)
False
Don’t start prophylaxis during an acute attack (start 2-4 weeks after the acute attack)
Once treatment has been started it can be continued during an acute attack
