Gout/pseudogout

Question 1

Crystals in acute gout called?

Answer 1

Monosodium urate monohydrate

Question 2

Crystals in pseudogout called?

Answer 2

Calcium pyrophosphate dihydrate

Question 3

plasma urate target

Answer 3

below 0.3

But takes a long time for crystal load to decrease after you get serum levels under control, so may still have attacks

WHilst this is going on, could consider prophylactic colchicine 0.5 mg daily or BD for first 6 months

Question 4

What does the fluid look like in pseudogout

Answer 4

often bloodstained

hand joints but also big joints

Question 5

RA and pseudogout assoc?

Answer 5

neg assoc

Question 6

classic foot joints in pseudogout

Answer 6

MTP 2 and 3

Question 7

treat pseudogout

Answer 7

aspirate joint
immpobilise with splint
NSAIDS
IA steroids 
systemic steroids 

educate, exercise, reduce obesity, simple analgesia

Question 8

what is negatively birefringent?

Answer 8

YeLLow when paraLLel to polarising light = neg

Yellow up hill tilt, blue downhill tilt if see

Question 9

what is BCP disease?

Answer 9

basic calcium phosphate hydroxyapatite

need EM for diagnosis
present with shoulder or rotator cuff or hip or knee or wrist tendonitis/bursitis
can have local tendon rupture

SHoulder x ray with calcified tendon- this is it
Can cause massive blown up shoulder because of bloody effusion- milwaukee shoulder

Question 10

Gout RF

Answer 10

metabolic syndrome
insulin resistance
obesity
cardiac failure
organ transplant
diuretics
CKD

Question 11

Mechanism of hyperuricaemia

Answer 11

usually from renal under-excretion

Question 12

Why is gout more common in men?

Answer 12

Oestogen promotes excretion uric acid

Question 13

Urate is a metabolic product of what

Answer 13

purine

(most from endogenous load from tissue breakdown, 30% denovo via PrPP synthase or from diet)

Excretion into gut is via ABCG2

Question 14

Which diet thing PROTECTS against gout

Answer 14

dairy

Question 15

How many attacks will have high uric acid?

Answer 15

half only!

Question 16

Cyclosporine and gout

Answer 16

cyclo lowers urinary clearance

Question 17

Key mediator gout inflammation

Answer 17

IL-1B

Question 18

ACute gout

Answer 18

NSAIDS
colchicine

second line
IACS
systemic CS

Question 19

MOA colchicine

Answer 19

affects NEUTROPHIL function by inhibiting microtubule polymerisation-essential for mitosis

Question 20

What does nasty overdose of colchicine look like?

Answer 20

First GI sx

Then rhabdo and BM failure

Question 21

What do you give for chronic tophaceous gout

Answer 21

cholchicine 0.5-1mg dailuy (though beware neuromyopathy long term)
NSAID
CS
Il-1 inhibitor (Canakinumab)

Question 22

colchicine in renal impairment

allopurinol in renal impairment

Answer 22

Colchicine:
not for acute attack if taking prophylactic colchicine and crcl under 80
If cr cl under 30, cannot repeat within 2 weeks

CAN use but lower dose for prophylaxis

allopurinol:
start low and titrate up according to target under 0.36 or 0.3 if tophi present

Question 23

strongest comorbid assoc with gout is

Answer 23

hypertension

the antihypertensives that increase urate clearance are losartan and amlodipine