Gout and pseudogout

Question 1

What is the pathophysiology of gout

Answer 1

deposition of monosodium urate monohydrate in synovium

Question 2

What are the causes of gout?

Answer 2

reduced uric acid excretion:
- diuretics 
- CKD
- lead toxicity
increased uric acid production:
- myeloproliferative disorders
- cytotoxic drugs 
- severe psoriasis

Question 3

What are the clinical features of gout?

Answer 3

pain
swelling
erythema
essentially is an inflammatory arthritis

Question 4

What joints are affected in gout?

Answer 4

70% in 1st MTP joint
Ankle
Wrist
Knee

Question 5

How long do episodes of gout last for?

Answer 5

several days

Question 6

What can be seen on imaging in gout>?

Answer 6

Joint effusion
‘punched out’ erosions w sclerotic margins
Preservation of joint space until late disease
Soft tissue tophi

Question 7

What is the management of acute gout?

Answer 7

NSAIDs w colchicine

If contraindications - use prednisone 15mg OD PO

Question 8

What is the management of chronic gout?

Answer 8

ULT (urate lowering therapy)

Allopurinol - don’t start until 2 weeks after attack

Question 9

What lifestyle changes can be done to help with gout?

Answer 9

reduce alcohol
lose weight
avoid high purine foods - liver, kidney

Question 10

What is the pathophysiology of pseudo gout?

Answer 10

deposition of calcium pyrophosphate on joint surface

crystals elicit inflammatory response

Question 11

What joints are affected in pseudo gout?

Answer 11

MCPS, joints and wrist

Question 12

What is seen on XR in pseudogout?

Answer 12

chondrocalcinosis

Question 13

What is the management of pseudogout?

Answer 13

aspiration to exclude septic joint

NSAIDs or steroids as for gout

Question 14

Explain the differences between gout and pseudogout

Answer 14

gout:
- monosodium urate
- NEGATIVE birefringent needle shape crystals
pseudogout:
- calcium pyrophosphate
- POSITIVE birefringent rhomboid crystals