Gout and Pseudogout (1) Flashcards
What can this either be? What type of crystals would be causing these?
How does it present?
→ Based on this, what needs to be excluded?
➊ Gout (Uric acid crystals) or Pseudogout (Calcium Pyrophosphate crystals)
➋ Hot, swollen, stiff, painful joint
→ Septic Arthritis
Investigations:
What is needed for a definitive diagnosis?
→ What will be seen with Gout? What are the features of these crystals?
→ What will be seen with Pseudogout? What are the features of these crystals?
→ MC&S should also be done on this. What would you expect?
What would XR show?
What are 2 key bloods to do in Gout?
➊ Joint aspiration with subsequent polarised light microscopy
→ Uric acid crystals - Needle-shaped, Negative birefringent (NN)
→ Calcium pyrophosphate crystals - Rhomboid-shaped, Positive birefringent
→ • No bacteria (its presence → septic arthritis)
• Raised WCC (a much higher value → septic arthritis)
➋ Chondrocalcinosis as a thin white line in the joint space
➌ • Uric acid – Lowering the levels of this (e.g. w/allopurinol), will reduce the risk of further attacks
• U&E – Renal impairment is a risk factor for gout
N.B. Thiazide and loop diurectics, Low-dose aspirin, and Chemotherapy can cause hyperuricaemia, therefore increasing the risk of gout
How is it managed?
What can be given to prevent it?
➊ * Supportive as symptoms usually resolve over several weeks
* NSAIDs
* Colchicine is an alternative if NSAIDs contraindicated e.g. CKD, but it carries a high risk of GI disturbance, esp. diarrhoea
* Steroids if stage 5 CKD
N.B. Co-prescribe a PPI for those at high risk of GI complications
➋ Allopurinol
