Locomotor: Gout

Question 1

what is gout?

Answer 1

a syndrome characterised by: hyperuricaemia and deposition of urate crystals causing attacks of acute inflammatory arthritis

Question 2

what areas of the body does gout most commonly affect?

Answer 2

The disease most commonly affects the first toe (podagra), foot, ankle, knee, fingers, wrist, and elbow; however, it can affect any joint.

Question 3

what are the three distinct phases of gout?

Answer 3

1. asymptomatic hyperuricaemia (long)
2. acute attack of gouty arthritis followed by intervals with no symptoms
3. chronic tophaceous gout, where people have nodules affecting joints.

Question 4

what are the risk factors for developing gout?

Answer 4

• hyperuricaemia
• male
• increasing age
• hypertension
• hyperparathyroidism
• chronic renal disease
• menopausal women
• obesity
• alcohol
• metabolic syndrome
• dyslipidaemia
• dietary intake of purines
• family history

Question 5

which medications can rise plasma rate levels and consequently cause an attack of gout?

Answer 5

ACE inhibitors, beta-blockers, ciclosporin, diuretics,pyrazinamide, ritanovir, tacrolimus, aspirin, and lead exposure

Question 6

what are the clinical features of gout?

Answer 6

• rapid onset severe pain
• joint stiffness
• few affected joints
• swelling and joint effusion
• tenderness
• tophi

Question 7

which conditions present in a similar way to gout?

Answer 7

Pseudogout.
Septic arthritis.
Trauma. 
Rheumatoid arthritis. 
Reactive arthritis.
Psoriatic arthritis.

Question 8

what investigation would you conduct to confirm a diagnosis of gout?

Answer 8

Physical examination

Arthrocentesis (shows rate crystals)

bloods uric acid level

Question 9

when should a uric acid level be checked with reference to an attack of gout?

Answer 9

Should be obtained at least 2 weeks after the attack resolves, as it may be falsely low or normal during the attack.

Result: >416 micromol/L (7 mg/dL) in men; >360 micromol/L (6 mg/dL) in women.

Question 10

what is the first line treatment for an acute gout?

Answer 10

NSAID

e.g. naproxen or ibuprofen

Question 11

what is the second line treatment for an acute gout?

Answer 11

colchicine

used when NSAIDs are contraindicated

Question 12

what is the third line treatment for an acute gout?

Answer 12

Corticosteroid (prednisolone)

Question 13

what is the first line treatment for an ongoing/recurrent gout?

Answer 13

Allopurionol

NB: should be started 2-3 weeks post acute episode. It should not be started during an acute attack as it might prolong the attack or precipitate more attacks.

Question 14

what is the second line treatment for an ongoing/recurrent gout?

Answer 14

Febuxostat

should only be prescribed for patients who have failed treatment with or can not tolerate allopurinol, and who have been counseled regarding cardiovascular risk

Question 15

what are some complications of gout?

Answer 15

• tophi
• urinary stones
• chronic kidney disease
• myocardial infarction