Joint Inflammation

Question 1

What are the features of GOUT?

Answer 1

• Significant pain
• Swelling
• Erythema

Can last several days but are often symptom - free between episodes. Mostly affects the 1st MTP joint - can also affect ankle, wrist and knee

CXR Findings:

• Joint effusions
• Juxta-articular ‘Punched out’ erosions (rat’s bite)
• No periarticular osteopenia

Question 2

What are the predisposing factors towards GOUT?

Answer 2

1. Decreased excretion of uric acid (Drugs, CKD, lead toxicity)
2. Increased production of uric acid (myelo/lymphoproliferative disorder, cytotoxic drugs, severe psoriasis)
3. Lesch-Nyhan syndrome
   An X-linked recessive diseases that features gout, renal failure, neurological deficits, learning difficulties, self-mutilation

Question 3

What is the management of GOUT (ACUTE)?

Answer 3

• NSAIDs/Colchicine
• Oral steroids if the first 2 are contraindicated (prednisolone). May also use intra-articular steroid injection
• Continue taking allopurinol

Offer urate-lowering therapy to all patients after FIRST attack of gout

Question 4

What are the indications for Urate-lowering therapy (ULT)?

Answer 4

• Offer after FIRST attack of gout
• > 2 attacks in 12months
• Tophi
• Renal disease
• Uric acid renal stones
• Prophylaxis if on cytotoxic/diuretics

Use allopurinol as first line

Question 5

What other managements are needed for GOUT?

Answer 5

• Lifestyle modifications (reduce alcohol intake/avoid during attack)
• Weight loss
• Avoid foods high in purines (liver, kidneys, seafood, oily fish, yeast products)
• Consider stopping precipitating drugs (thiazides)
• Consider losartan which has a specific uricosuric action
• Increase Vit C intake