Gout and Pseudogout Flashcards
What is Gout?
Chronically high levels of blood uric acid-urate crystals deposited in the joint
What are the main risk factors for Gout?
- High purine diet
- Obesity
- Cardiovascular or renal problems
- Alcohol
- Diuretics (loop and thiazide)
How does Gout present?
Acute hot, swollen, painful joint
What joint is mainly affected?
Metatarsophalangeal joint- Big toe
What 2 other joints are commonly affected by Gout?
- Knee
* Base of the thumb-carpometacarpal joint
How is Gout diagnosed?
Aspirate the joint
What would you find in the joint aspiration?
Needle shaped monosodium urate crystals with negative birefringence
What other investigations would you do for Gout?
X-ray
What would you find on an x-ray of Gout?
Osteolytic lesions and punched out erosions
What is the management of Gout?
NSAID or Colchicine
What is the prophylaxis for Gout?
Allopurinol
What would you do if a patient presented with a flare up of gout on allopurinol?
Add colchicine
What is pseudogout?
Caused by deposition of calcium pyrophosphate dihydrate crystals
What would you find in the joint aspiration of pseudogout?
Romboid shaped weakly positive birefringent shaped crystals
How does pseudogout present?
Acutely painful and swollen joint
What would you find on an x-ray of pseudogout?
Chondrocalcinosis
What is the management of pseudogout?
NSAIDs or
Intra-articular, intra-muscular or oral steroids
Is the joint space maintained in someone with gout?
yes
When should uric acid levels be measured in someone with gout?
2 weeks after the attack
Why shoudl the uric acid levels be measured after the attack of gout?
The uric acid level can be falsely low or normal during the attack
What is the main NSAID used in the management of Gout?
Indomethacin
When would colchicine be preferred over an NSAID in the management of Gout?
If there is a history of chronic kidney disease or heart failure
What is the main side effect of colchicine?
Diarrhoea
What can be used in teh management of gout of the side effects of colchicine are not tolerated?
Intrarticular steroids
What lifestyle changes can be implemented in the management of gout?
Reduction of alcohol and purine-based foods
Weight loss
What medications can increase the amout of uric acid in the body?
Thiazides and loop diuretics
Low dose salicylates
Chemotherapy
What is gouty tophi?
Subcutaneous deposits of uric acid typically affecting the small joints and connective tissues of the hands, elbows and ears.
The DIP joints are most affected in the hands.
What is chondrocalcinosis?
Thin white line in the middle of the joint space caused by the calcium deposition
Deposition of which crystals is psuedogout due to?
Calcium pyrophosphate crystals
Which joints are usually affected by pseudogout?
Main-Knee
Other joints that are commonly affected are the shoulders, wrists and hips.
