Gout & Pseudogout Flashcards
What is gout?
An acute monoarthropathy
With severe joint inflammation
Caused by deposition of monosodium urate crystals
Presentation of gout?
Usually metatarsophalangeal joint of big toe
Severe pain, reduced ROM, can’t wait bear, painful to tough even with bed sheets
In long term, urate deposits (tophi) in pinna, tendons, joints. These are chalky
And renal disease (uric acid stones)
What causes gout?
Genetics High dietary purines: meat, fish Alcohol Tumour lysis syndrome Drugs: diuretics
Diseases associated: CVS disease Diabetes II Leukaemia Hypertension CKD
What can precipitate an attack of gout?
Trauma Surgery Starvation Infection Diuretics
Investigations of gout?
Polarised light microscopy of synovial fluid = negatively bi-refringent urate crystals (needle shaped)
Serum urate raised
XR: soft tissue swelling, later on: punched out erosions seen in juxta-articular bone
Management of acute gout attack?
High dose NSAID
If contra-indicated give colchicine
Rest and elevation, ice packs
Long term management of gout?
Lifestyle: lose weight, low purine diet
Start drugs if more than 1 attack in 12 months or presence of tophi and renal disease
Allopurinol
What is pseudogout?
Similar to gout only deposition of calcium pyrophosphate crystals
Typically of larger joints
Risk factors for pseudogout?
Elderly
Hyperparathyroidism
Haemochromatosis
Hypophosphataemia
Investigations of psuedogout?
Polarised light microscopy of synovial fluid = weakly positive bi-refringent crystals of caclium pyrophosphate which are rhomboid shape
XR: calcium deposition in soft tissues
Management of pseudogout?
Cool packs, rest
Aspiration
Intra-articular steroids
NSAIDs
Colchicine
Chronic: methotrexate or hydroxychloroquinone
