Orthopaedics & Rheumatology\ Gout

Question 1

What is the pathogenesis of gout?

Answer 1

• Deposition of monosodium urate crystals in tissues or supersaturation of the extracellular fluids

Question 2

What is the relationship between hyperuricemia and gout?

Answer 2

• All patients who develop gout have hyperuricemia at some point in their disease

Question 3

Will all patients with hyperuricemia develop gout?

Answer 3

No

Question 4

What are risk factors for developing gout?

Answer 4

• Male sex
• age between 30 and 50
• obesity
• hypertension
• alcohol use

Question 5

What medications can lead to increased uric acid levels?

Answer 5

• Thiazide diuretics
• loop diuretics
• aspirin

Question 6

Which joint is most commonly affected in this disease?

Answer 6

First MTP joint (ie, podagra)

Question 7

What are the symptoms of an acute gouty attack?

Answer 7

• Intensely painful
• warm
• red
• swollen joint that is extremely tender to the touch

Question 8

What common urologic condition can someone with gout develop?

Answer 8

Uric acid kidney stones

Question 9

Describe the time-course of an acute gouty attack.

Answer 9

Inflammation reaches its peak intensity within several hours, and resolves within a few days to weeks

Question 10

What is the differential diagnosis of an acute gout attack?

Answer 10

• Pseudogout
• acute septic arthritis
• bacterial cellulitis
• traumatic injury to joint

Question 11

What is the definitive diagnostic test for gout?

Answer 11

• Aspiration of synovial fluid from the affected joint or tophaceous material and visualisation of monosodium urate crystals under polarised light

Question 12

What do monosodium urate crystals look like under microscopy?

Answer 12

• Needle- or rod-shaped
• negatively birefringent crystals
• are yellow when parallel to the axis of slow vibration

Question 13

What is the first line of treatment for an acute gouty attack?

Answer 13

• NSAIDs (eg, indomethacin) starting at a high dose, decreased as tolerated, and stopping treatment 48 hours after the attack resolves

Question 14

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?

Answer 14

Colchicine

Question 15

What drugs may be used if NSAIDs or colchicine are contraindicated or ineffective?

Answer 15

• Corticosteroids (intra-articular or systemic)

Question 16

What prophylaxis is available for patients with recurrent gout?

Answer 16

• Antihyperuricemic or
• uricosuric agents

Question 17

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?

Answer 17

• Allopurinol
  
  • xanthine oxidase inhibitor –> decreases the production of uric acid

Question 18

What uricosuric agent is commonly used and how does it work?

Answer 18

• Probenecid —> increases the excretion of uric acid

Question 19

When should you start prophylactic medications for gout?

Answer 19

• post an acute attack

Question 20

Uric acid is a waste product from the breakdown of what organic product?

Answer 20

Purines

Question 21

What food items are high in purines?

Answer 21

• Organ meats (such as liver)
• fish (especially herring and mackerel)

Question 22

What is the effect of fasting and rapid weight loss on uric acid levels?

Answer 22

increases uric acid

Question 23

Moderate consumption of alcohol, especially beer, as much as doubles the likelihood of developing gout. True or false?

Answer 23

True

Question 24

What is the name for the deposition of uric acid crystals built up in the soft tissue of a gouty joint?

Answer 24

Gouty Tophus