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Rheumatology > Gout > Flashcards

Gout Flashcards

1
Q

What is gout?

A

An inflammatory arthritis relating to hyperuricaemia.

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2
Q

Where does gout commonly affect?

A
  • The first MTPJ of the foot
  • Ankle, foot, small joints of hand, wrist, elbow, knee
    It can be polyarticular
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3
Q

What are the non modifiable risk factors for gout?

A

Age >40

Male gender

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4
Q

What are the modifiable risk factors for gout?

A

Reduced urate excretion - Renal disease, post menopausal, hypertension, diuretics, antihypertensives, aspirin

Excess urate production - Dietary, alcohol, high fructose, genetic disorders, lympho/myeloproliferative disorders, drugs (warfarin, cytotoxics)

Associations - CVD, hypertension, DM, renal failure

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5
Q

What should you screen for in a patient with gout?

A
  • CKD
  • Hypertension
  • Dyslipidaemia
  • Diabetes
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6
Q

How do you investigate gout?

A
  1. Exclude septic arthritis first with joint aspirate (in any acute monoarthropathy)
  2. Consider reactive arthritis, haemarthrosis, CPPD and palindromic RA
  3. Urate crystals will be found in joint aspirate
  4. Radiographs show soft tissue swelling early on, but later on show well defined punched out erosions
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7
Q

How do you treat acute gout?

A
  1. High dose NSAID’s
  2. If CI, use colchicine
  3. If renally impaired, consider IM steroids
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8
Q

How can you prevent gout?

A
  1. Maintain optimum weight
  2. Regular exercise
  3. Diet modification - purine rich meats and avoid long periods of starvation
  4. Low dose aspirin
  5. Stop smoking and reduce alcohol
  6. Maintain fluid intake
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9
Q

What prophylaxis can you give for gout?

A
  • Allopurinol / Febuxostat
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10
Q

What are the indications for prophylaxis?

A
  • Over 1 attack in 12 months
  • Tophi
  • Renal stones
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11
Q

What is the class of allopurinol?

A

Xanthine oxidase inhibitor

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12
Q

What is the aim of plasma urate

A

<0.3mmol/L

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13
Q

What are some side effects of allopurinol?

A
  • Low WCC
  • Rash
  • Fever
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14
Q

Why do you wait after an acute attack to give allopurinol?

A
  • It may cause an acute episode again so wait 3 weeks

- Cover with a regular NSAID for up to 6 weeks

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15
Q

What are some long term complications of gout?

A
  • Urate deposits (tophi) in pinna, tendons and joints

- Renal disease - Stones and interstitial nephritis

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16
Q

What is pseudogout?

A
  • Caused by calcium pyrophosphate crystals
  • Mainly occurs in older women with OA
  • Affects larger joints
  • Same treatment as gout but mostly supportive

Rheumatology (9 decks)

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