Gout + Pseudogout Flashcards
what is gout
an acute mono arthritis caused by deposition of urate crystals within a joint
what is gout due to
high levels of uric acid
- >7mg/dL
what is uric acid
the final breakdown product of purines (adenine + guanine) in DNA metabolism
what can cause hyperuricaemia
renal under excretion
- diuretics
- renal failure
lifestyle
- excessive alcohol
- red meat
- seafood
presentation of gout
rapid onset hot, red, swollen, extremely painful joint
what site is most commonly affected by gout
1st MTP
what are gout tophi
painless white accumulations of uric acid in soft tissues that can erupt through skin
diagnostic investigation for gout
joint aspiration + microscopy
what would joint aspiration show in gout
needle shaped negatively birefringent uric acid crystals
when should serum urate be measured in gout?
2 weeks following attack
- serum urate lowered during attack due to precipitation of urate crystals in the body
1st line treatment of acute gout
NSAIDs
Colchicine if can’t tolerate NSAIDs
2nd line treatment of acute gout
steroids (oral or intra-articular)
long term gout prophylaxis
1st line - allopurinol
2nd line - febuxostat
(start 2 weeks after attacks)
when is long term prophylaxis indicated
recurrent (>2 attacks)
complications (tophi, stones)
patient on diuretics
mechanism of action allopurinol
xanthine oxidase inhibitor
- prevents conversion of xanthine to uric acid
