Gout/crystal arthropathy Flashcards
What is gout
Rapid onset crystal arthritis
Typical presentation of gout acute
intense pain and swelling, acute attacks typically affect the first metatarsal-phalangeal joint (MTP of the great toe
What is gout triggered by
Hyperuricaemia due to pruine breakdown -> accumulation of monosodium urate crystals
Who does gout affect
Mot common men 30-50
Risk factors for gout
Genetics - FH
Diet - purine rich foods
Alcohol
Metabolic syndrome - DM, lipids, HPTN
Renal function - CKD
Meds - thiazide diuretics, asporon, anti-TB
Chronic gout features
tophi formation 9nodules of crystals surrounded by crhonic uinflammation), joint damage, and chronic pain.
When does gout appear and resolve
Max severity in 24 hours, resolves 5-15 days
Where can be affected in gout
First MTP on foot
Other joints of the feet, ankle and knee
Joints of the hand, wrist and elbow.
It rarely affects more central joints such as hip and spine.
Features of joint gout
Intense stabbing pain
Eythema
Joint swell + tenderness -> decreased ROM
Investigaitons for gout
Clinical features and historu
Synovial fluid aspiration if nexessary
Serum uric acid after 4-6 weeks or chronic gout
Clinical diagnosis
Criteria for gout diagnosis
Mono-articular involvement of a foot/ankle joint
Previous episodes of a similar nature
Rapid onset
Erythema
Male
What need to screen for when diagnosis of gout made
CVS risk and risk of kidney disease
When to use synovial fluid analyiss
Only when diagnosis unsure or spetic arthritis suspected
What is gold standarard investigation for gout
Fine needle aspiration is 100% sepcific
Differntiates gout and pseudogout
What crystals are found in gout
Monosodium nitrate
negative birefrigent
Needle shaped
What crystals are found in pseudogout
Positively birefringent
Rhomboidal
Calcium pyrophosphate
What is raised uric acid
> 360
Bloods in gout
Raised uric acid, U+Es for allopurinol, WCC raised, glucose and lipids (meatbolic synd ass)
When is readiology used in gout
Chronic
X rays in chronic gout
Joint effusion
Punched out lytic lesions
Sclerotic margins
Outlines of tophi
Tophi on US
Hyperechoic - white appearance
Management of gout goal
Reduce pain and inflamamtion
Prevent falres and reduce joint pain
Acute management gout
NSAIDs
Colichine
Oral steroids if these contraindicated
Long term amangement gout
Lifestyle
Allopurinol
Febuxosat if not tolerated
When avoid colichine
may be used with caution in renal impairment: the BNF advises to reduce the dose if eGFR is 10-50 ml/min and to avoid if eGFR < 10 ml/mi
Can cause diarrhoea
When is allopurinol indicated
> 2 attacks in 12 months
Tophi
Renal disease
Uric acid renal stones
Prophylaxis if on cytotoxics or diuretics
Delay until inflammation from attack settles but carry on through attack if already on it
Allopurinol dose and aim
100mg OD, <360
<300 if - tophi, chronic gouty arthritis
Refractory cases of gout management
Pegloticase - rapid control - infusion once every two weeks
Lifestyle modifications in gout
duce alcohol intake and avoid during an acute attack
lose weight if obese
avoid food high in purines e.g. Liver, kidneys, seafood, oily fish (mackerel, sardines) and yeast products
Stop taking precipitating drugs
Losartan can be beneficial
Complications gout
Tophi
Bone complications -> degenerative arthritis
20% increased risk of osteoporosis
Renal - can cause kidney disease
Mental health
Risk factors for pseudogout
Haemochromatosis
Hyperparathyroidism
Acromegaly
Low Mg, low phosphate
Wilsons disease
Clinical features of pseudogout
knee, wrist and shoulders most commonly affected
joint aspiration: weakly-positively birefringent rhomboid-shaped crystals
x-ray: chondrocalcinosis
in the knee this can be seen as linear calcifications of the meniscus and articular cartilage
