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MSK > Gout / Pseudogout > Flashcards

Gout / Pseudogout Flashcards

1
Q

Where do we get urate from

A

Purines in DNA and diet

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2
Q

What does HGPRT do

A

Salvage DNA bases so purine is not made

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3
Q

What causes overproduction of urate

A 
Malignancy 
Myeloproliferative disorder
Drugs - Warfarin 
Alcohol 
HGPRT deficiency (Lesch Nyan) 
Exercise
Psoriasis
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4
Q

What causes under excretion of urate

A 
Renal impairment / CKD
Hypertension
Hypothyroid 
Drugs - diuretics 
Exercise 
Starvation / dehydration 
Lead poisoning as affects kidney 
Aspirin but not if cardioprotective
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5
Q

What is LEsch Nyan syndrome and how is it inherited

A 
HGPRT deficiency 
X-linked recessive 
Intellectual disability 
Aggressive
Gout
Renal disease
Self mutilation
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6
Q

What is gout and what can precipitate

A

Deposits of monosodium urate crystals in joints
Causes inflammatory response

Trauma
Surgery
Starvation
Infections
Diuretics
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7
Q

What are the RF for gout

A 
Men 
Women after menopause as oestrogen protective 
Age due to reduced renal 
Renal impairment 
Obesity 
DM 
High cholesterol
High BP 
Alcohol 
Diureitcs 
Dehydration
Surgery 
INfection
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8
Q

How does gout present

A 
Acute monoarthrtis (60% big toe MTP) 
Can occur in ankle, foot, hand, elbow 
Occurs overnight
Red, painful, hot and shiny - looks septic 
Swelling  
Tophi can build up (uric crystals in soft tissue) 
Lasts 7-10 days 
Symptom free between
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9
Q

What are the renal complications of gout

A

Radiolucent stones

Interstitial nephritis

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10
Q

How do you Dx gout and what does microscopy show

A

Aspiration + gram stain + culture (to exclude infection)
Polarised light microscopy shows -ve bifringenet needle shaped crystals
Increased urate in blood
X-Ray

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11
Q

What does X-ray show

A 
Joint effusion
Lytic lesion 
Erosions + sclerosis
Joint space loss = late sign 
NO OSTEOPENIA (RA)
Soft tissue tophi or swelling
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12
Q

How do you treat an acute flare up of gout

A

Aggressive Ax till SA excluded
NSAID = 1st line (may need PPI)
Colchicine = 1st line if NSAID CI
Oral / IM steroids if both CI e.g. if renal failure etc.
Intra-articular steroid injection can be used

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13
Q

What must you make sure

A

Kidney function okay

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14
Q

DDX of gout

A 
Septic arthritis
Pseduogout
OA
Haemarthrosis
Reactive arthritis
Cellulitis
Bursitis
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15
Q

When do you treat prophylactically 1st attack of gout

A 
Polyarticular
Tophi 
Urate calculi in kidney
Renal insufficiency
Cytotoxic / diuretics
Lesch Nyan
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16
Q

When do you usually give prophylaxis

A

2nd attack within 1 year or prior to Rx of malignancy

17
Q

How do you lower uric acid

A

Allopurinol (xanthine oxidase inhibitor) = 1st ilne

Uricosuric agent = Lorsartan

18
Q

When do you start

A

Once attack has settled as can often worsen
Wait 2 weeks
NSAID / colchicine cover should be used when starting

19
Q

What must else you do

A 
Address CVS / lifestyle
Reduce alcohol
Weight loss
Avoid high purine foods
Increase vit C 
Review drugs and consider stopping diuretics etc
20
Q

What is calcific periarthritis

A

Deposit of calcium phosphate hydroxyl-apatite

21
Q

What is pseudgout

A

Deposits of calcium pyrophosphate dehydrate

22
Q

What are the symptoms of pseudogout

A

Erractic flares of acute monoarthropathy
Flares usually last weeks with months in between in contrast to gout which last days
Associated OA
Affects knee and wrist like gout affect toe

23
Q

Who is at risk

A 
Elderly female 
Age 
OA
DM
Hypothyroid
Hyperparathyroid
Haemochromatosis
Wilson
Acromegaly
HypoMg / phosphate
24
Q

How do you Dx and what does miscropscy show

A 
X-ray 
Joint aspiration to exclude SA
Light microscopy 
- +ve Bifrigent rhomboid blue crystal 
Bloods for cause - U+E, iron, PTH, TFT
Blood culture
25
Q

How do you Rx

A 
Address metabolic / endocrine
NSAID
Cochichine
Steroids
No prophylaxis
DMARD for chronic
26
Q

What is seen on X-ray that is Dx of pseudogout

A

Chondocalcinosis - calcification of articular cartilage

27
Q

DART causes of gout

A

Diuretic
Alcohol
Renal
Trauma

28
Q

Do you treat hyperuric alone

A

No

Only if symptomatic of gout

29
Q

What can cochicihine cause

A

Diarrhoea

30
Q

What are SE of Allopurinol

A

Dermatological

  • DRESS
  • SJS
31
Q

What does Allopurinol interact with

A

Azathioprine (much lower dose needed)
Cyclophosphamide - marrow toxicity as reduces renal clearance
Theophylline - inhibits breakdown

32
Q

Gout vs pseudo gout microscopy

A 
Gout = -ve brifringent needle shape
Pseudo = +Ve bifrignetn rhomboid

MSK (21 decks)

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