Gout Flashcards
What can precipitate gout attacks?
Trauma, surgery, starvation, infection, diuretics
What are risk factors for gout?
Middle aged, overweight, male, high purine diet, increased cell turnover
What is the pathophysiology of gout?
Monosodium urate crystals are deposited in and near joints
What is the key enzyme in the production of uric acid?
Xanthine oxidase
How does gout typically present?
Acute monoarthropathy with severe joint inflammation. Joints are hot, swollen and painful - tophi
Where are the most common sites for gout?
Metatarsophalangeal joint of big toe, distal interphalangeal joints
What will a polarised light microscopy of synovial fluid show?
Needle-shaped negatively birefringent monosodium urate crystals
What will serum urate be?
Normal or raised
What will later X-rays show?
Well-defined punched out erosions in juxta-articular bone
What should you exclude?
Septic arthritis
What should you consider as differential diagnoses?
Reactive arthritis, haemarthrosis, pseudogout, palindromic RA
How do you manage gout?
High dose NSAID, colchicine, allopurinol
What does allopurinol do?
It’s a xanthine oxidase inhibitor
What are the main complications?
Infection in the tophi, destruction of the joint
What are tophi?
Stone-like deposits of monosodium urate
