Gout Features Flashcards
Features of gout
Gout is a form of inflammatory arthritis.
Px have episode lasting several days with gout flares and are symptom-free.
- pain: this is often very significant
- swelling
- erythema
Most commonly affected joints
1st Metatarsophalangeal joint
- Ankle
- Wrist
- Knee
Radiological features of gout:
Joint effusion is an early sign
Punched- out erosions wit sclerotic margins in a juxta-articular distribution
Relative preservation joint space until late disease
Eccentric erosions
Acute management of Gout
NSAIDs or colchicine are first-line - max dose of NSAID
Gastroprotection
Colchicine- slower onset of action
Side-effect is diarrhoea
Use steroids if NSAIDs and Oral colchicine contraindicated
Continue allopurinol
Indications for urate lowering therapy
Offer urate-lowering therapy to all patients after their first attack of gout
ULT is particularly recommended if:
>= 2 attacks in 12 months
tophi
renal disease
uric acid renal stones
prophylaxis if on cytotoxics or diuretics
Urate lowering therapy
Allopurinol first- line - 100mg od initially
Colchicine cover should be considered when starting allopurinol
Second- line- when allopurinol is contraindicated- febuxostat
Lifestyle modifications for Gout
reduce 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
What is Gout
Gout is a form of microcrystal synovitis caused by the deposition of monosodium urate monohydrate in the synovium. It is caused by chronic hyperuricaemia (uric acid > 0.45 mmol/l)
Decreased excretion of uric acid causes
drugs*: diuretics
chronic kidney disease
lead toxicity
Increased production of uric acid causes
myeloproliferative/lymphoproliferative disorder
cytotoxic drugs
severe psoriasis
What is pseudogout
Form of microcrystal synovitis caused by th edeposition of calcium pyrophosphate dihydrate crystals in the synovium
Pseudogout underlying risk factors
haemochromatosis
hyperparathyroidism
low magnesium, low phosphate
acromegaly, Wilson’s disease
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
Management of pseudogout
aspiration of joint fluid, to exclude septic arthritis
NSAIDs or intra-articular, intra-muscular or oral steroids as for gout
Which drug should NOT be prescribed with azathioprine in the management of acute gout and why
Azathioprine and allopurinol have a severe interaction causing bone marrow suppression
