Gout X3

Question 1

Gout

Answer 1

inflammatory rthritis with a cardinal feature of hyperuricema
with will precipitate into monosodium urate crystals and that deposties into the joint leading to pain and inflammation

Question 2

Hyperuricema

Answer 2

eceeding 6.8mg dl

Question 3

Gout risks

Answer 3

M>F 
-post menopausal women
Advnaced age
Pacific islander 
genetics 
Comorbid
DM, HTN, Obestit, Hyperlipidemia 
Diet rich in meat or seafood, sugar Etoh and certain meds

Question 4

Stages of hout

Answer 4

1. asymptomatic hyperuricema
2. Acute Gouty arthritis
3. Intercritical gout
   - asymptomatic between gout attacks
4. Chronic gouty arthritis
   - if original gout is left untreated
   - involved joints will developed chronic swelling tophi

Question 5

Acute Gout flare presentation

Answer 5

-often monoarticular ( can be polyarticular)
- 1st MTP is most common location for intial attack
> ankle, heel, wrist, fingers, elbow
- often recurrent but usually the attack is self limiting about 2 wks
Rapid onset (often at night), severe pain, pain peaks 8-12 hours, redness warmth welling,

Question 6

Medications that can result in gout

Answer 6

Thiazide or loop diuretics
low dose aspirn
niacin
cyclosporine A
Urate-lowering medications

Question 7

Gout Dx

Answer 7

Xray
1.Arthrocentesis and synovial fluid analysis > definitive diagnosis
> polarized light micropscopy looking at monosodium urate chrystals NEEDLE SHAPED and NEGATIVELY BIFRINGENT
2. Serum URic Acid LEvel
- most accurate 2 wks after gout flare
3. Urinary Uric acid
- just to see if they excrete less than <800mg to know if they are a candiade for uricosurc theray

Question 8

Tx of acute gout flare

Answer 8

Pain/Inflam:

1. NSAIDS
   - most pt if no contraindications
2. glucocorticoids
3. colchicine
   - typically reserved for pt who cannot take NSAIDS

Question 9

Indication for urate lowering therapy

Answer 9

• frequent gout flares
• structural joint damge
• tophaceous depositis
• CrCl,60ml/min
• recurrent uric acid nephrolithiasis

Question 10

ULT

Answer 10

Xanthine Oxidase Inhibitors 
-allopurinol and febuxostat 
-allo is the agent of choice and we start low and slow 
* SJS risk 
Urcosuric Agents 
- pprobenecid 
- indicated for underextretors too and requires good renal function
-Biologic ULT 
- Pegloticase IV for refrectory gout

Question 11

Initiating ULT

Answer 11

Wait till acute flare is over!!! at least 2 wks

- can use prophylactic tx- colchicine or NSAIDS

Question 12

Pseudogout (CPPD) etilogy

Answer 12

Calcium pyrophosphate christal deposits
- often idiopathic
Risks: jiont trauma ( injury, OS etc), familial chondrocalcinosis
*Hemochromatosis and hyperparathyroidim are in high associated hypomag hypophos

Question 13

CPPD present

Answer 13

Severe acute inflamation
** Knee is the most common
trauma surgery or severe illness often provoke attack

Question 14

Radiographic findings of CPPD

Answer 14

Chondrocalcinosis- evidencce of CPP deposists

- can also be associaed with other degenerati changes

Question 15

Arthrocentesis/ synovial fluid analysis of CPPD

Answer 15

POSIVELY BIREFRINGENT CPP chrystals
rhomboid shaped chrystals
*definitive diagnosis

Question 16

Spondyloarthropathy SpA types

Answer 16

Axial
- back pain SI joint or spine
-ankylosing spondylitis 
-nonradiographic axial   
Pheripheral 
ex: reactive arthritis, psortiatc arthritis, arthritis associated with IBS 
- peripheral artheritis
-Enthesitisis
-dactylitis

Question 17

Reactive artitis

Answer 17

Acute asptic inflammatory arthritis