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ICC2 > gout and pseudogout > Flashcards

gout and pseudogout Flashcards

1
Q

what is gout ?

A

clinical syndrome caused by inflammatory response to monosodium urate monohydrate crystals which develops secondary to hyperurecemia

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2
Q

when is it rare to see gout ?

A

in premenopausal women and in children

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3
Q

what is the level where we can say a patient is hyperuremic ?

A

> 6 mg/dl or >360umol

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4
Q

what is uric acid a metabolite of ?

A

purine -> hypoxanthine -> xanthine -> uric acid

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5
Q

what are the classification of hyperuricemia ?

A

underexcretion

overproduction

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6
Q

what are the causes of underexcretion ?

A

chronic renal failure
drugs ( CAN’T LEAP)
cyclosporin, alcohol, nicotinic acid, thiazides, lasix ethambutol, aspirin, pyrazinamide
idiopathic or genetic

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7
Q

what are the causes of overproduction ?

A 
polycythemia 
leukemia 
chronic hemolytic anemia 
psoriasis 
cytotoxic drugs used in malignancy ( tumor lysis syndrome)
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8
Q

what are the 3 stages of presentation of gout ?

A

acute attack
intercritical period
arthropathy / nephropathy

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9
Q

what is the presentation of acute gout ?

A

affecting the base of the big toe
usually monoarticular
rapid onset with swelling pain and erythema
may have normal urate levels during the attack
fever
raised WCC ESR

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10
Q

where are the non articular depositions in acute gout ?

A

olecranon bursa and achilles tendon

achilles tendon

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11
Q

what drug should be avoided in an acute attack of gout ?

A

allopurinol, prolongs attack

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12
Q

what is the presentation of chronic gout ?

A

main presentation includes the presence of tophi
tophaceous gout

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13
Q

where can we find tophi ?

A 
helix of the ear 
fingers 
eyelids
olecranon bursa 
achilles tendon
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14
Q

how do urate crystals appear under polarized light microscopy ?

A

needle shaped crystals that appear bright yellow (strongly bifrengent)

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15
Q

what are the radiological findings in acute on chronic gout ?

A

punched out well defined lesion
subarticular cysts
joint space narrowing

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16
Q

what are the radiological findings inn acute gout ?

A

soft tissue swelling around the first MTP

17
Q

what is important about the introduction or withdrawal of hypouricemic drugs during attack ?

A

the introduction or withdrawal of these drugs cannot be done without the use of colchine/NSAIDs as urate levels may change during the attack

18
Q

how to treat an acute attack ?

A

cold pack, rest
anti-inflammatory
colchine
short course of oral steroids

19
Q

what is the main side effect of colchine ?

A

GIT intolerance - diarrhea

20
Q

what are the indications of giving hypouricemic drugs ?

A 
tophaceous gout 
radiographic erosions 
uric acid nephrolithiasis 
urate nephropathy 
recurrent attacks of gout ( 2 attacks a year)
21
Q

asymptomatic hyperuricemia do we give hypouricemic drugs ?

A

nope , but modify the risk factors

22
Q

what are the xanthine oxidase inhibitor drugs ?

A

allopurinol works for overproduction and underproduction

febuxostat

23
Q

what kind of clearance does allopurinol have ?

A

renal clearance

24
Q

what kind of clearance does febuxostat have ?

A

hepatic clearance

25
Q

which drug could be used if the patient has renal impairment ?

A

febuxostat because it has hepatic clearance

26
Q

what are the novel therapies available ?

A

uricosuric drugs
recombinant uricase
Urat-1 inhibitor
IL-1 trap

27
Q

when can we use uricosuric drugs ?

A

patients with proper renal funnction

28
Q

what is the risk of using uricosuric drugs ?

A

renal calculi

29
Q

what do recombinant uricase drugs help inn n?

A

debulking tophi

30
Q

what is the disadvantage of using recombinant uricase ?

A

formation of neutralizing antibodies

31
Q

what other anti inflammatory drug can we use during an attack of gout ?

A

IL-1 trap

32
Q

which drug causes a drug-drug interaction with colchicine ?

A

clarithromycin or azithromycin

33
Q

what antibiotic can be suitable to avoid drug-drug interaction with colchicine if the patient is allergic to penicillin?

A

erythromycin due to risk of rhabdomyolysis

34
Q

what other calcium deposition disease can present with pseudo gout or pseudo arthiritis ?

A

calcium pyrophosphate dihydrate crystal deposition , which is more common in females

35
Q

where are the sites of deposition of CPD crytals ?

A 
pubic symphysis 
knee 
wrist 
shoulders 
intervertebral space
36
Q

what do the crystals under light microscopy look like in pseudogout ?

A

clump of pyrophosphate crystals (rhomboid-shaped) in blood stained synovial fluid ( weakly bifringed)

37
Q

what are the radiological findings in pseudogout ?

A

calcified hyaline cartilage and fibrocartilage with linear and spotty appearance
well preserved joint space

38
Q

what are the main precipitants of gout ?

A

acute illness
trauma
surgery
alcohol
starvation
drugs

ICC2 (42 decks)

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