Gout and pseudogout Flashcards
What is the pathophysiology of gout?
Raised serum uric acid forms crystals that build up into tophi which the body identifies as foreign so recruits WBC’s that cause inflammation and pain
What is the clinical presentation of gout?
A painful mono-arthritis with recurrent flares of joint inflammation
Who is most likely to develop gout?
Men and older women
How is uric acid excreted?
Kidneys mainly (70%)
What is the link between gout, alcohol intake, and BMI?
Risk increases with increased alcohol consumption
- Especially beer (risk 2.51), followed by spirits (risk 1.6)
Increased BMI increases risk
- BMI >35 risk 2.97
What is the difference between hyperuricaemia and gout?
Gout: once monosodium urate monohydrate crystals are deposited into joints
Hyperuricaemia: elevated uric acid levels
Which diseases is hyperuricaemia linked to?
- Cardiovascular disease linked death
- Endothelial dysfunction leading to atherosclerotic plaques
- Chronic kidney disease
How is gout managed?
Acute:
- Colchicine, NSAID + PPI, or prednisolone
Long-term:
- Education
- Lifestyles changes: diet, weight loss, reduce alcohol intake
How does allopurinol work?
It’s a xanthene oxidase inhibitor (decreases production of uric acid in the body)
It’s prevent attacks of gout, but doesn’t treat them in acute attacks
What are the different preventive medications for gout?
- Allopurinol
- Febuxostat
- Uricosuric agents Eg. benzbromarone and probenecid
How does febuxostat work?
A ABCG2 inhibitor
- Works by lowering production of uric acid
Typically used after Allopurinol has been tried
What is pseudogout?
AKA calcium pyrophosphate crystal deposition (CPPD) disease or chondrocalcinosis
Usually affects knees, shoulders, and ankles
It can mimic gout
What is the difference between gout and pseudogout?
Gout: monosodium urate monohydrate crystals
Pseudogout: calcium pyrophosphate crystals
What is the treatment for pseudogout?
Joint aspiration and steroid injections
There’s nothing available no prevention available or treatment for reposits already present
