Gout and pseudogout Flashcards
Gout is a type of crystal arthropathy - what does this mean?
Joint disorders caused by deposits of crystals in joints and the soft tissues around them
Gout is associated with chronically high blood levels of what?
Uric acid (hyperuricemia)
In gout, urate crystals are deposited in the joint causing what symptoms?
Swollen, hot, painful joints
1) What are the subcutaneous deposits of uric acid in gout called?
2) Where do these deposits in the small joints and connective tissues most commonly occur (3)?
3) Which joints in the hand are most commonly affected?
1) Gouty tophi
2) Hands, elbows and ears
3) DIP joints
Name 3 risk factors for developing gout
- Male
- Obesity
- High purine diet (e.g. meat and seafood)
- Alcohol
- Diuretics
- Existing cardiovascular or kidney disease
- Family history
Name 2 joints gout more commonly impacts
- Base of the big toe (metatarsophalangeal)
- Wrists
- Base of thumb (carpometacarpal)
- Knee and ankle
1) How is gout normally diagnosed, and what is seen?
2) What serum test can be done in gout?
3) When diagnosing gout, what is important to exclude?
4) Name a feature of a joint xray of a patient with gout
1) Aspiration of fluid from the joint - negatively birefringent needle shaped (monosodium urate) crystals
2) Measure serum urate 2 weeks after attack
3) Septic arthritis
4) Typically the space between the joint is maintained, lytic lesions in the bone, punched out erosions, erosions can have sclerotic borders with overhanging edges. Erosions in the subchondral bone
1) During and acute flare of gout, what is the 1st line management?
2) During and acute flare of gout, what is the 2nd line management?
1) NSAIDs
2) Colchicine (gastric upset = s/e)
1) What drug can be used as a prophylactic measure for gout?
2) How does this work?
3) Lifestyle changes can also be beneficial - name 2 of these changes that can be beneficial
1) Allopurinol (given with NSAID/colchicine cover)
2) Xanthine oxidase inhibitor - decreases uric acid levels
3) Losing weight, staying hydrated and minimising the consumption of alcohol and purine-based food
Pseudogout is also crystal arthropathy, but what crystal is it caused by?
calcium pyrophosphate crystals (aka chondrocalcinosis)
What is the typical presentation of pseudogout?
Older adult with a hot, swollen, stiff, painful knee
As well as the knee joint, name 2 other joints that pseudogout can impact
Shoulders, wrists and hips
How is pseudogout diagnosed?
Aspirated joint fluid showing calcium pyrophosphate crystals (weakly positive birefringent rhomboid shaped crystals)
Chondrocalcinosis is the classic xray change in pseudogout - what is seen?
thin white line in the middle of the joint space caused by the calcium deposition (this is also diagnostic of pseudogout). Can be seen as linear calcification on knee xray
Symptoms usually resolve spontaneously over several weeks, but symptomatic management is also an option (same management as gout - NSAIDs, colchicine etc). In severe cases, how can it be managed?
Joint washout - arthrocentesis
