Hot, Painful, Swollen joint Flashcards
List the causes of hot swollen joints
- Septic arthritis (must not miss)
- Gout
- Pseudogout
- Haemarthrosis
- Psoriatic arthritis
- Reactive arthritis
What is gout?
A crystal arthropathy whereby urate crystals become deposited into the joint causing it to become hot, swollen and painful
What are gouty trophi?
Subcutaneous deposits of uric acid
Which joints are most commonly affected by gouty trophi?
DIP joints
What are the risk factors for gout?
- Male gender
- Obesity
- High purine diet (meat, seafood)
- Alcohol
- Diuretics
- Existing cardiovascular disease or kidney disease
- FHx
What are the typical joints that are affected by gout?
- Base of the big toe (metatarsophalangeal joint)
- Wrists
- Base of the thumb (carpometacarpal joints)
What investigation is diagnostic for gout?
Aspiration of the joint fluid for MC&S
What will a gout flare joint fluid aspiration look like?
- No bacterial growth
- Needle shaped crystals
- Negatively birefringent of polarised light
- Monosodium urate crystals
What will be seen on a gout X-Ray?
- Joint space usually maintained
- Lytic lesions in the bone
- Punched out erosions
- Erosions with sclerotic borders and overhanging edges
How would you manage a gout patient in an acute flare?
1st line. NSAIDs
2nd line. Colchicine (use in those when NSAIDs are inappropriate)
3rd line. steroids
What is the prophylactic treatment for gout?
Allopurinol
Lifestyle changes
When should you consider offering urate lowering treatment (ULT)?
- recurrent attacks (>2 in 12 months)
- Tophi
- Chronic gouty arthritis
- Joint damage
- renal impairment
- history of urolithiasis
- Diuretic therapy use
- primary gout starting at a young age
What drug class is allopurinol?
Xanthine oxidase inhibitor (XOI)
