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Joints, bones and skin > Gout/crystal arthropathy > Flashcards

Gout/crystal arthropathy Flashcards

1
Q

What is gout

A

Rapid onset crystal arthritis

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2
Q

Typical presentation of gout acute

A

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

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3
Q

What is gout triggered by

A

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

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4
Q

Who does gout affect

A

Mot common men 30-50

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5
Q

Risk factors for gout

A

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

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6
Q

Chronic gout features

A

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

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7
Q

When does gout appear and resolve

A

Max severity in 24 hours, resolves 5-15 days

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8
Q

Where can be affected in gout

A

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.

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9
Q

Features of joint gout

A

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

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10
Q

Investigaitons for gout

A

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

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11
Q

Criteria for gout diagnosis

A

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

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12
Q

What need to screen for when diagnosis of gout made

A

CVS risk and risk of kidney disease

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13
Q

When to use synovial fluid analyiss

A

Only when diagnosis unsure or spetic arthritis suspected

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14
Q

What is gold standarard investigation for gout

A

Fine needle aspiration is 100% sepcific
Differntiates gout and pseudogout

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15
Q

What crystals are found in gout

A

Monosodium nitrate
negative birefrigent
Needle shaped

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16
Q

What crystals are found in pseudogout

A

Positively birefringent
Rhomboidal
Calcium pyrophosphate

17
Q

What is raised uric acid

A

> 360

18
Q

Bloods in gout

A

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

19
Q

When is readiology used in gout

A

Chronic

20
Q

X rays in chronic gout

A

Joint effusion
Punched out lytic lesions
Sclerotic margins
Outlines of tophi

21
Q

Tophi on US

A

Hyperechoic - white appearance

22
Q

Management of gout goal

A

Reduce pain and inflamamtion
Prevent falres and reduce joint pain

23
Q

Acute management gout

A

NSAIDs
Colichine
Oral steroids if these contraindicated

24
Q

Long term amangement gout

A

Lifestyle
Allopurinol
Febuxosat if not tolerated

25
Q

When avoid colichine

A

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

26
Q

When is allopurinol indicated

A

> 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

27
Q

Allopurinol dose and aim

A

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

28
Q

Refractory cases of gout management

A

Pegloticase - rapid control - infusion once every two weeks

29
Q

Lifestyle modifications in gout

A

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

30
Q

Complications gout

A

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

31
Q

Risk factors for pseudogout

A

Haemochromatosis
Hyperparathyroidism
Acromegaly
Low Mg, low phosphate
Wilsons disease

32
Q

Clinical features of pseudogout

A

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

Joints, bones and skin (31 decks)

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