MSRA: Gout

Question 1

What are the signs and symptoms of an acute gout?

Answer 1

Excruciating, sudden, unexpected, burning pain and 4 cardinal signs of acute inflammation
The pain peaks 12-24 hours from the onset
Commonly in the big toe (Podagra)
Low grade fever

Question 2

What are the risk factors for gout?

Answer 2

Alcohol
Thiazide diuretics
Male
Renal impairment
Age
Red meat, fish, drinks sweetened with fructose

Question 3

What is the management of an acute gout attack?

Answer 3

NSAIDs for 1-2 days after the attack has resolved with PPI cover
Colchicine if NSAIDs not tolerated
Corticosteroids can be considered
Don’t start Allopurinol
Continue Allopurinol if started previously

Question 4

What is the main side effect of Colchicine?

Answer 4

Diarrhoea

Question 5

What is the mechanism of action of Allopurinol?

Answer 5

Xanthine oxidase inhibitor

Question 6

What x-ray changes are seen in late disease?

Answer 6

Punched out erosions

Question 7

What type of crystals are typically seen on joint aspirate in gout?

Answer 7

Needle shaped crystals with negative berfringence

Question 8

What type of crystals are typically seen on joint aspirate in pseudogout?

Answer 8

Positive befringence
Box/rhomboid shaped crystals

Question 9

When to start a patient on Allopurinol?

Answer 9

Offer urate lowering therapy to all patients after their first attack of gout, delay starting until the inflammation has settled

Starting Allopurinol may precipitate an acute attack, so cover with Colchinene or NSAID if CIs to Colchicene