Gout HYHO Flashcards
Briefly discuss sources of purines in the human body and purine metabolism and degradation
Sources: diet, nucleotide synthesis and metabolism.
Excretion occurs in 2 organs:
Kidneys (70%)
Gut (30%)
Discuss the epidemiology and risk factors for gout
Affects about 4% of adults in US
Risk factors:
Male sex, age, obesity, HPT, hyperlipidemia, cardiovascular disease, CKD, Medications (thiazides), diet, lead exposure
Discuss the clinical presentation of gout and pseudogout
Affected joint is typically swollen, erythematous, warm, and exquisitely painful.
More common in 1st MTP joint (podagra)
Knee joints
Ankle joints
Discuss the differential dx of gout and pseudogout
CPPD deposition (pseudogout) Septic arthritis Cellulitis Rheumatoid arthritis Osteoarthritis Psoriatic arthritis Sarcoidosis
What are some supporting labs/tests for dx gout?
Serum uric acid level
CBC with dif
XR not helpful in acute gouty flares, in chronic may reveal bony erosions
What should you be cautious of in pts with gout and CKD?
NSAIDs and colchicine use.
Preferred to use intra-articular steroids injection or oral steroids
What is the treatment of acute gouty flare?
NSAIDs, colchicine, glucocorticoids
What is the treatment of chronic gout?
Xanthine oxidase inhibitors (wait 2 weeks after flare). Allopurinol and febuxostat.
Uricosuric agents: inhibit reabsorption of uric acid in proximal convuleted tubule.
Probenecid, lesinurad
What is the treatment of chronic gout?
Xanthine oxidase inhibitors (wait 2 weeks after flare). Allopurinol and febuxostat.
Uricosuric agents: inhibit reabsorption of uric acid in proximal convuleted tubule.
Probenecid, lesinurad
Uricase: (humans lack) converts uric acid into the highly soluble allantoin
Pegloticase, used in severe gout when other treatments have failed
Epidemiology and risk factors for pseudogout
Age>60
Osteoarthritis
Clinical presentation pseudogout
Affected joint is typically swollen, erythematous, warm, and painful.
More common in:
knee joints, wrist joints, rarely 1st MTP joint
In contrast with gout, acute attacks of CPPD disease can last for weeks to months.
Provoking factors include surgery or acute illness
How do you dx pseudogout?
Arthrocentesis.
Under polarized light microscopy, will see CPP crystals, which are rhomboid shaped and positively birefringent under polarized light.
XRs can support the dx of pseudogout with finding of chondrocalcinosis (cartilage calcification)
What is the treatment for pseudogout?
NSAIDs
Colchicine
Intra-articular glucocorticoid injection or oral prednisone
Treat underlying metabolic disease if present
What is the treatment for pseudogout?
NSAIDs
Colchicine
Intra-articular glucocorticoid injection or oral prednisone
Treat underlying metabolic disease if present
What is the WBC count for non-inflammatory arthritis synovial fluid?
<2,000
