Gout and Pseudogout

Question 1

What is Gout?

Answer 1

Chronically high levels of blood uric acid-urate crystals deposited in the joint

Question 2

What are the main risk factors for Gout?

Answer 2

• High purine diet
• Obesity
• Cardiovascular or renal problems
• Alcohol
• Diuretics (loop and thiazide)

Question 3

How does Gout present?

Answer 3

Acute hot, swollen, painful joint

Question 4

What joint is mainly affected?

Answer 4

Metatarsophalangeal joint- Big toe

Question 5

What 2 other joints are commonly affected by Gout?

Answer 5

• Knee

* Base of the thumb-carpometacarpal joint

Question 6

How is Gout diagnosed?

Answer 6

Aspirate the joint

Question 7

What would you find in the joint aspiration?

Answer 7

Needle shaped monosodium urate crystals with negative birefringence

Question 8

What other investigations would you do for Gout?

Answer 8

X-ray

Question 9

What would you find on an x-ray of Gout?

Answer 9

Osteolytic lesions and punched out erosions

Question 10

What is the management of Gout?

Answer 10

NSAID or Colchicine

Question 11

What is the prophylaxis for Gout?

Answer 11

Allopurinol

Question 12

What would you do if a patient presented with a flare up of gout on allopurinol?

Answer 12

Add colchicine

Question 13

What is pseudogout?

Answer 13

Caused by deposition of calcium pyrophosphate dihydrate crystals

Question 14

What would you find in the joint aspiration of pseudogout?

Answer 14

Romboid shaped weakly positive birefringent shaped crystals

Question 15

How does pseudogout present?

Answer 15

Acutely painful and swollen joint

Question 16

What would you find on an x-ray of pseudogout?

Answer 16

Chondrocalcinosis

Question 17

What is the management of pseudogout?

Answer 17

NSAIDs or

Intra-articular, intra-muscular or oral steroids

Question 18

Is the joint space maintained in someone with gout?

Answer 18

yes

Question 19

When should uric acid levels be measured in someone with gout?

Answer 19

2 weeks after the attack

Question 20

Why shoudl the uric acid levels be measured after the attack of gout?

Answer 20

The uric acid level can be falsely low or normal during the attack

Question 21

What is the main NSAID used in the management of Gout?

Answer 21

Indomethacin

Question 22

When would colchicine be preferred over an NSAID in the management of Gout?

Answer 22

If there is a history of chronic kidney disease or heart failure

Question 23

What is the main side effect of colchicine?

Answer 23

Diarrhoea

Question 24

What can be used in teh management of gout of the side effects of colchicine are not tolerated?

Answer 24

Intrarticular steroids

Question 25

What lifestyle changes can be implemented in the management of gout?

Answer 25

Reduction of alcohol and purine-based foods
Weight loss

Question 26

What medications can increase the amout of uric acid in the body?

Answer 26

Thiazides and loop diuretics
Low dose salicylates
Chemotherapy

Question 27

What is gouty tophi?

Answer 27

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.

Question 28

What is chondrocalcinosis?

Answer 28

Thin white line in the middle of the joint space caused by the calcium deposition

Question 29

Deposition of which crystals is psuedogout due to?

Answer 29

Calcium pyrophosphate crystals

Question 30

Which joints are usually affected by pseudogout?

Answer 30

Main-Knee
Other joints that are commonly affected are the shoulders, wrists and hips.