Gout And Pseudogout

Question 1

What is gout.

Answer 1

Uric acid arthropathy.

Question 2

Who is most affected by gout. (2)

Answer 2

Men are more affected than women.

4:1.

Question 3

What are the risk factors for gout. (8)

Answer 3

Increased dietary purine intake. 
Alcohol. 
Increased cell turnover (eg malignancy). 
Cytotoxins (tumour lysis). 
Hereditary. 
Low dose aspirin. 
Diuretics. 
Inherited enzyme deficiencies.

Question 4

What are the symptoms of acute gout. (3)

Answer 4

Monoarthritis with severe joint inflammation.
Severe pain lasting 7-10days.
Most commonly first metatarsophalangeal joint (podagra, 50%).

Question 5

What are the symptoms of chronic gout. (3)

Answer 5

Gouty tophi on pinnae, tendons, joints.
There may be polyarthritis. 
Renal disease (stones, interstitial nephritis).

Question 6

What are seen on Xrays of a patient with gout. (2)

Answer 6

Cortical erosions.

Sclerotic margins.

Question 7

What is pseudogout.

Answer 7

Calcium pyrophosphate arthropathy.

Question 8

What are the causes of pseodogout. (6)

Answer 8

May be primary.

May be secondary to: hyperparathyroidism, haemochromatosis, diabetes, Wison’s disease, hypothyroidism.

Question 9

What is seen on the Xrays of a patient with pseudogout.

Answer 9

Chondrocalcinosis.

Question 10

What is found on joint aspiration in patients with pseudogout.

Answer 10

Positively birefringent urate crystals.

Question 11

What is found on joint aspiration in patients with gout.

Answer 11

Negatively birefringent urate crystals (when polarized light microscopy is done).

Question 12

What is raised on blood results of a patient with gout.

Answer 12

Raised uric acid levels.

Question 13

What are the joints that may be affected in gout. (7)

Answer 13

Big toe. 
Ankle. 
Foot. 
Small joints of the hand. 
Wrists. 
Elbow. 
Knee.

Question 14

What is the differential diagnosis for a patient presenting with gout. (3)

Answer 14

First exclude septic arthritis in any acute monoarthropathy.
Then consider haemarthrosis, CPPD and palindromic RA.

Question 15

What are the conditions associated with gout. (4)

Answer 15

Cardiovascular disease.
Hypertension.
DM.
Chronic renal failure.

Question 16

What are the symptoms of gout caused by.

Answer 16

By the deposition of monosodium urate crystals in and near joints.

Question 17

What may precipitate gout. (5)

Answer 17

Trauma. 
Surgery. 
Starvation. 
Infection. 
Diuretics.

Question 18

What is seen on XR in a patient with gout. (2)

Answer 18

Early stages may show soft tissue welling.

Later, well defined ‘punched-out’ erosions are seen in juxta-articular bone.

Question 19

What is preserved in gout.

Answer 19

Joint spaces are preserved until late.

There is no sclerotic reaction.