Orthopaedics & Rheumatology\ Gout Flashcards
What is the pathogenesis of gout?
- Deposition of monosodium urate crystals in tissues or supersaturation of the extracellular fluids
What is the relationship between hyperuricemia and gout?
- All patients who develop gout have hyperuricemia at some point in their disease
Will all patients with hyperuricemia develop gout?
No
What are risk factors for developing gout?
- Male sex
- age between 30 and 50
- obesity
- hypertension
- alcohol use
What medications can lead to increased uric acid levels?
- Thiazide diuretics
- loop diuretics
- aspirin
Which joint is most commonly affected in this disease?
First MTP joint (ie, podagra)
What are the symptoms of an acute gouty attack?
- Intensely painful
- warm
- red
- swollen joint that is extremely tender to the touch
What common urologic condition can someone with gout develop?
Uric acid kidney stones
Describe the time-course of an acute gouty attack.
Inflammation reaches its peak intensity within several hours, and resolves within a few days to weeks
What is the differential diagnosis of an acute gout attack?
- Pseudogout
- acute septic arthritis
- bacterial cellulitis
- traumatic injury to joint
What is the definitive diagnostic test for gout?
- Aspiration of synovial fluid from the affected joint or tophaceous material and visualisation of monosodium urate crystals under polarised light
What do monosodium urate crystals look like under microscopy?
- Needle- or rod-shaped
- negatively birefringent crystals
- are yellow when parallel to the axis of slow vibration
What is the first line of treatment for an acute gouty attack?
- NSAIDs (eg, indomethacin) starting at a high dose, decreased as tolerated, and stopping treatment 48 hours after the attack resolves
What drug may be used for acute gout which is effective in reducing symptoms, but has limited use because it causes GI toxicity in up to 80% of patients?
Colchicine
What drugs may be used if NSAIDs or colchicine are contraindicated or ineffective?
- Corticosteroids (intra-articular or systemic)
What prophylaxis is available for patients with recurrent gout?
- Antihyperuricemic or
- uricosuric agents
What antihyperuricemic agent is commonly used and how does it work? What uricosuric agent is commonly used and how does it work? Probenecid, increases the excretion of uric acid When should you start these prophylactic medications? AFTER an acute attack Uric acid is a waste product from the breakdown of what organic product? Purines What food items are high in purines? Organ meats (such as liver), fish (especially herring and mackerel) What is the effect of fasting and rapid weight loss on uric acid levels?
- Allopurinol
- xanthine oxidase inhibitor –> decreases the production of uric acid
What uricosuric agent is commonly used and how does it work?
- Probenecid —> increases the excretion of uric acid
When should you start prophylactic medications for gout?
- post an acute attack
Uric acid is a waste product from the breakdown of what organic product?
Purines
What food items are high in purines?
- Organ meats (such as liver)
- fish (especially herring and mackerel)
What is the effect of fasting and rapid weight loss on uric acid levels?
increases uric acid
Moderate consumption of alcohol, especially beer, as much as doubles the likelihood of developing gout. True or false?
True
What is the name for the deposition of uric acid crystals built up in the soft tissue of a gouty joint?
Gouty Tophus
