Gout - finished Flashcards
Define gout
A group of diseases caused by Na+ urate deposition within connective tissues and other tissues.
What are some risk factors for gout
Girls risky fuck MAD OAF
Male: female = 20:1
Age (men over 45 and postmenopausal women)
Diet (high in purines)
Obese
Alcohol (beer)
Family Hx
Hyperuricaemia - concentration?
Uric acid reaches saturation at approx 0.42mmol/L.
The higher the concentration in blood, the higher the risk of developing gout
If over concentration level, 20% of people develop gout
Diagnosis of gout:
Clinical picture and physical examination
Hx of:
- familial incidence
- post attack
Hyperuricaemia:
- usually proceeds the acute attack
- is common in middle aged men
- is NOT pathognomonic
The presence of Birefringent urate crystals in the synovial fluid of in phagocytes IS DIAGNOSTIC
Gout is diagnosed as it Can Have Horrible Bouts
What are the radiol manifestations of gout?
Acute:
- ST swelling
Angry girls are RAD because theyre SOFT
Chronic:
- Tophi
- Overhanging margins
- Narrowing of joint space
- Secondary OA
College girls are RAD because they do TONS
What is a tophus?
An aggregation of crystals within the synovium and in other connective tissue sites eg bone skin and tendons
What is stage 1 of gout? What happens in this stage?
ASYMPTOMATIC HYPERURICAEMIA
- urate crystals deposit and form over weeks/months
- the immune system largely ignores these crystals
- crystals are microscopic, birefringent and needle shapes
- urate deposits may contribute directly to organ damage
What is stage 2 of gout? What happens in this stage?
ACUTE GOUTY ARTHRITIS
- Sufficient urate deposits develop around the joint
- A traumatic or other precipitating event triggers the release of crystals into the joint space
- Acute inflammation results (acute attack)
Acute inflammation caused by:
- crystals stimulate increased synthesis of inflam mediators.
- phagocytosis of crystals by neutrophils = release of lysosomal products which result in WBC chemotaxis.
- phagocytosis of crystals by macrophages = secretion of IL-1
What are typical triggers for acute attacks of gout?
Triggers for acute gout are TRAUMI
Trauma Recent increase in alcohol or purines Acute infection hyperUricaemia Medication use IV contrast dye exposure
What is stage 3 of gout? What happens in this stage?
INTERCRITICAL PERIOD
Inflammation has resolved but there is still a persistent build up of crystals in the joint, bursae, tendons, periarticular tissues.
Most pts experience a second attack within a year of the first.
What is stage 4 of gout? What happens in this stage?
CHRONIC TOPHACEOUS GOUT
Characterised by chronic arthritis and tophi
Build up of crystals in the joint, bursae, tendons, periarticular tissues
The build up of crystals results in synovial proliferation and pannus formation.
Pannus formation results in:
- destruction of underlying articular cartilage
- eventual destruction of subchondral bone
- proliferation of marginal bone
What is a tophus? Size?
A mass of urates surrounded by an intense inflammatory reaction made up of:
- macrophages
- lymphocytes
- fibroblasts
- foreign body giant cells
They can be from <1mm to several centimetres
Tophi are pathognomonic for Gout
What are the typical sites for tophi?
Olecranon bursae
MTP’s
Achilles tendon
Pinnae of the ears (in cartilage)
What is the typical patient for Gout?
Over 30
Obese
Hypertensive
Family Hx of gout
Alcohol
Red faced
Male
What is the clinical picture of acute gout?
Angry Girls take pictures at night In Sexy Skinny Jocks
Sudden onset
Nocturnal
Intense pain and tenderness
Skin:
- Swollen, red, tense, shiny, warm
Joint:
- Feels hot, extremely tender, limited ROM
- Monoarticular
- 50-90% of initial attacks are in 1st MTP
