Gout + Pseudogout Flashcards
what is the most common type of inflammatory monoarticular arthritis?
gout
a patient presents with intense painful swelling of a single joint on their foot. Dx?
gout
what joint in the foot is most commonly affected by gout?
great toe MCP joint
what joint in the foot is the 2nd most common site affected by gout?
ankle
how is gout caused? (2)
high levels of uric acid
high purine diet
what medications can cause gout?
hypertensive medications
the build up of uric acid forms ________ ______ that lodge into joints
needle-like crystals
excess uric acid can increase the risk for which 4 chronic conditions?
diabetes
obesity
heart disease
kidney disease
a patient presents with intense joint pain, often started at night and wakes them up, it has swelling, redness, warmth, and stiffness. The patient has difficulty bearing weight and with ROM of the affected joint. Dx?
gout
how long do gout flare ups typically last?
1-2 weeks
identify phase of gout: elevated levels of serum uric acid, formation of crystals in joints, asymptomatic.
asymptomatic hyperuricemia
identify phase of gout: patient is experiencing an attack of pain and swelling.
acute gouty arthritis (flare up)
identify phase of gout: the patient has recovered from their flare up and is now asymptomatic.
intercritical gout
identify phase of gout: crystals build up in skin (tophi) or other areas of the body, patient has had multiple flare ups, and can result in destructive arthropathy and chronic secondary osteoarthritis
chronic tophaceous gout
another word for a gouty flare up of the MCP joint of the great toe
podagra (acute gout)
what labs will indicate gout?
serum uric acid > 7
what gives the definitive diagnosis of gout? what will it show?
joint aspiration
negative needle-shaped urate crystals
what is the 1st line treatment for acute gout?
indomethacin + colchicine
what is the 2nd line treatment for acute gout?
steroids
when should serum urate lowering therapy be started?
at least 2 flare ups per year
OR
tophi or history of nephrolithiasis
what is the serum urate target with serum urate lowering therapy?
less than 5-6
what is the 1st line serum urate lowering therapy?
allopurinol (xanthine oxidase inhibitor)
what is the 2nd line serum urate lowering therapy if allopurinol doesn’t work?
febuxostat (xanthine oxidase inhibitor)
what is the risk with febuxostat?
cerebrovascular
what is the 3rd line serum urate lowering therapy?
probenecid (uricosuric agent)
what is the last option for serum urate lowering therapy, used for refractory gout despite maximum dosage therapy?
pegloticase (uricase)
what is the prophylaxis treatment for gout?
low dose colchicine + serum urate lowering therapy
monoarticular arthritis also known as calcium pyrophosphate dihydrate crystal deposition disease (CPDD), most often affecting the knee
pseudogout
what gives the most definitive diagnosis of pseudogout? what will it show?
joint aspiration
positive rhomboid shaped crystals
what will be seen on xray to indicate pseudogout?
chondrocalcinosis (cartilage calcification)
what is the 1st line treatment for pseudogout? (3)
bracing
indomethacin (NSAID)
low dose colchicine
what is the 2nd line treatment for pseudogout?
steroids
what is the treatment option for pseudogout in end-stage arthritis?
joint replacement
what is the prophylaxis for pseudogout?
low dose colchicine
