Gout & Pseudogout Flashcards

1
Q

What is gout?

A
  • inflammatory arthritis
  • microcrystal synovitis caused by the deposition of monosodium urate monohydrate in the synovium. It is caused by chronic hyperuricaemia (uric acid > 0.45 mmol/l)
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2
Q

What is the presentation of gout?

A
  • pain: this is often very *significant swelling
  • erythema
  • 70% affect 1st MTP joint
  • Other joints: ankle, wrist, knee
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3
Q

What are the predisposing factors for gout?

A

Decreased excretion of uric acid:

  • drugs i.e. diuretics
  • chronic kidney disease
  • lead toxicity

Increased production of uric acid:

  • myeloproliferative/lymphoproliferative disorder
  • cytotoxic drugs
  • severe psoriasis
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4
Q

What is the management of acute gout?

A
  • 1st: NSAIDs or colchicine are first-line
  • maximum dose of NSAID should be prescribed until 1-2 days after the symptoms have settled + PPI cover

*oral steroids may be considered if NSAIDs and colchicine are contraindicated
*another option is intra-articular steroid injection
if the patient is already taking allopurinol it should be continued

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5
Q

Prophylactic treatment for gout?

A

Medication:

  • Urate-lowering therapy
  • Allopurinol first line
  • initial dose of 100 mg od, with the dose titrated every few weeks to aim for a serum uric acid of < 300 µmol/l

Lifestyle:

  • Reduce alcohol and food high in purines
  • Lose weight
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6
Q

What the main finding is found on joint aspiration of gout?

A

*Negative birefringent, needle shaped crystals

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7
Q

What is pseudogout?

A

Form of microcrystal synovitis caused by the deposition of calcium pyrophosphate dihydrate crystals in the synovium.

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8
Q

What investigations is needed to diagnose pseudogout? Distinctive feature on investigations?

A

*joint aspiration: weakly-positively birefringent rhomboid-shaped crystals

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9
Q

What is the management of pseudogoat?

A
  • aspiration of joint fluid, to exclude septic arthritis

* NSAIDs or intra-articular, intra-muscular or oral steroids as for gout

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