Gout/crystal arthropathy

Question 1

What is gout

Answer 1

Rapid onset crystal arthritis

Question 2

Typical presentation of gout acute

Answer 2

intense pain and swelling, acute attacks typically affect the first metatarsal-phalangeal joint (MTP of the great toe

Question 3

What is gout triggered by

Answer 3

Hyperuricaemia due to pruine breakdown -> accumulation of monosodium urate crystals

Question 4

Who does gout affect

Answer 4

Mot common men 30-50

Question 5

Risk factors for gout

Answer 5

Genetics - FH
Diet - purine rich foods
Alcohol
Metabolic syndrome - DM, lipids, HPTN
Renal function - CKD
Meds - thiazide diuretics, asporon, anti-TB

Question 6

Chronic gout features

Answer 6

tophi formation 9nodules of crystals surrounded by crhonic uinflammation), joint damage, and chronic pain.

Question 7

When does gout appear and resolve

Answer 7

Max severity in 24 hours, resolves 5-15 days

Question 8

Where can be affected in gout

Answer 8

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.

Question 9

Features of joint gout

Answer 9

Intense stabbing pain
Eythema
Joint swell + tenderness -> decreased ROM

Question 10

Investigaitons for gout

Answer 10

Clinical features and historu
Synovial fluid aspiration if nexessary
Serum uric acid after 4-6 weeks or chronic gout
Clinical diagnosis

Question 11

Criteria for gout diagnosis

Answer 11

Mono-articular involvement of a foot/ankle joint
Previous episodes of a similar nature
Rapid onset
Erythema
Male

Question 12

What need to screen for when diagnosis of gout made

Answer 12

CVS risk and risk of kidney disease

Question 13

When to use synovial fluid analyiss

Answer 13

Only when diagnosis unsure or spetic arthritis suspected

Question 14

What is gold standarard investigation for gout

Answer 14

Fine needle aspiration is 100% sepcific
Differntiates gout and pseudogout

Question 15

What crystals are found in gout

Answer 15

Monosodium nitrate
negative birefrigent
Needle shaped

Question 16

What crystals are found in pseudogout

Answer 16

Positively birefringent
Rhomboidal
Calcium pyrophosphate

Question 17

What is raised uric acid

Answer 17

> 360

Question 18

Bloods in gout

Answer 18

Raised uric acid, U+Es for allopurinol, WCC raised, glucose and lipids (meatbolic synd ass)

Question 19

When is readiology used in gout

Answer 19

Chronic

Question 20

X rays in chronic gout

Answer 20

Joint effusion
Punched out lytic lesions
Sclerotic margins
Outlines of tophi

Question 21

Tophi on US

Answer 21

Hyperechoic - white appearance

Question 22

Management of gout goal

Answer 22

Reduce pain and inflamamtion
Prevent falres and reduce joint pain

Question 23

Acute management gout

Answer 23

NSAIDs
Colichine
Oral steroids if these contraindicated

Question 24

Long term amangement gout

Answer 24

Lifestyle
Allopurinol
Febuxosat if not tolerated

Question 25

When avoid colichine

Answer 25

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

Question 26

When is allopurinol indicated

Answer 26

>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

Question 27

Allopurinol dose and aim

Answer 27

100mg OD, <360 <300 if - tophi, chronic gouty arthritis

Question 28

Refractory cases of gout management

Answer 28

Pegloticase - rapid control - infusion once every two weeks

Question 29

Lifestyle modifications in gout

Answer 29

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

Question 30

Complications gout

Answer 30

Tophi Bone complications -> degenerative arthritis 20% increased risk of osteoporosis Renal - can cause kidney disease Mental health

Question 31

Risk factors for pseudogout

Answer 31

Haemochromatosis Hyperparathyroidism Acromegaly Low Mg, low phosphate Wilsons disease

Question 32

Clinical features of pseudogout

Answer 32

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