Gout Exam

Question 1

Hx 1

Answer 1

• Risk factors:
• M»F
• Obesity / larger body size
• EtOH
• Recent chemotherapy
• Positive family Hx
• High socioeconomic status
• Recent surgery
• Recent joint injury
• Diet high in purines rich foods (shellfish, offal)
• Typical Pt
• M, >30yo
• obese
• HTN
• Redfaced
• Shitfaced
• Look for a triggering event e.g. recent excessive food and/or alcohol consumption, stress etc
• Medication history: diuretics, salicylates etc
• Acute onset (within 1/7)
• Night attacks

Question 2

SSx- Timing / Stage 1

Answer 2

• specific manifestations will depend on Dz staging
• Stage 1 asymptomatic Hyperuricemia -> no SSx, lifestyle factors only
• Stage 2 Acute Gouty Arthritis is where we expect to see initial presentation

Question 3

SSx- Acute Gout / Articular

Answer 3

• key manifestation of acute joint inflammation
• lasts <2/52
• only one or a few joints affected:
• Commonly affects:
• MTP of the big toe (= podagra / 75%)
• toes, fingers, hands, feet, knees
• also hips, shoulders, elbows, and wrists
• Pt describes joint as:
• Rapid onset of severe pain: throbbing, crushing, or excruciating pain
• Marked tenderness: throbbing, burning, crushing, or excruciating pain
• Hot, swollen & tense - Erythematous & shiny
• Joint stiffness & ↓ed ROM

Question 4

SSx- Acute Gout / Extra Articular

Answer 4

• Pronounced periarticular soft tissue swelling
• Atypically Acute pain and tenderness of the heel or sole
• Malaise, fever & chills in more severe cases
• Bursitis - esp. olecranon

Question 5

SSx- Timing / Stage 3

Answer 5

• intercritical period -> asymptomatic
• follows acute gout
• most Pts suffer second attack within 1y
• Progresion to stage 4 (chronic gout) is uncommon -> >10y post initial acute episode.

Question 6

SSx- Chronic Gout / Articular

Answer 6

• Obs chronic joint inflammation resulting in Jt damage / destruction
• Chronic joint pain:
• regularly occurring;
• mild to moderate
• ↓ed ROM
• Pronounced stiffness
• Erythema and oedema are not as pronounced wrt acute
• Deformity
• Occasional acute flare ups

Question 7

SSx- Chronic Gout / Extra Articular

Answer 7

• Tophi - present as hard nodules:
• pathognomonic for Gout
• Size: from 1mm to several cm in diameter
• Commonly: over MTP of big toe, Achilles tendon, over olecranon bursa, pinnae of ears * Also occur under the skin over other joints e.g. hands
• Can appear anywhere in the body

Question 8

Complications

Answer 8

• cartilage degeneration -> 2ary OA
  Renal manifestations
• kidney stone development (urolithiasis)
• renal failure

Question 9

DDx

Answer 9

• septic arthritis
• pseudogout
• ReA
• PsA