Pseudo/gout Flashcards
What is the aetiology of gout?
There is a causal relationship between hyperuricaemia and gout. Uric acid can be raised from a mix of over production or under secretion. Risk factors for hyperuricaemia include dietary factors such as consumption of seafood, meat, and alcohol. Obesity, insulin resistance, and hypertension have also been implicated
What are the risk factors for gout?
Older age Menopause Obesity Diet Hypertension Male Diuretic use (thiazide and loop) Aspirin use Insulin resistance Renal insufficiency Hyperlipidaemia FH Gout
What is the presentation of gout?
Hot joint Swollen joint Red joint Joint pain and stiffness Affects feet joints Monoarticular and asymmetrical Tophi
What investigations should be done in gout?
Arthrocentesis- look at crystals under polarized red light and will see needle shaped sodium urate crystals (negatively birefringent) and increased WCC
Serum uric acid- will be over 360umol/L
Monitor for renal impairment
US affected joint
What dietary advice can be given for people with gout?
Advice to reduce alcohol intake, especially beer, which is high in purines and fructose, and consumption of non-diet carbonated soft drinks, which are also high in fructose, is essential; other dietary change include reduction of total calorie and cholesterol intake, and avoidance of purine-rich foods, such as offal, red meat, shellfish and spinach.
What is the pharmacological management of chronic gout?
Allopurinol with a starting dose of 100mg daily, taken after food
Febuxostat with a starting dose of 80mg daily then can increase to 160mg depending on the urate levels
Lesinurad 200mg daily used as adjunct with XOI
Suppressive therapy using NSAIDs or colchicine that should be continued for at least 3 months after achieving desired urate levels
Xanthine oxidase inhibitors reduce the production of uric acid and can rarely cause agranulocytosis
Uricosuric agent that inhibits uric acid transporters (URAT1 and OAT4) in the proximal tubule of the kidney. Careful use in renal disease.
What is the pharmacological management for acute gout?
Ibuprofen: 400-800 mg orally three to four times daily for 10-14 days
Diclofenac potassium: 50 mg orally (immediate-release) three times daily for 10-14 days
Indometacin: 25-50 mg orally three times daily for 10-14 days
Naproxen: 500 mg orally twice daily for 10-14 days
Prednisolone- 20-30mg daily for 5 days
Colchicine (SE of diarrhoea and nausea)- give max dose of 1.8mg
What is the aetiology of pseudogout?
Deposition of CPP (calcium pyrophosphate) crystals in the mid-zone of articular hyaline and fibro-cartilage
What are the risk factors for pseudogout?
Advanced age Injury Hyperparathyroidism Haemochromatosis Family history of CPPD Hypomagnesaemia Hypophosphatasia Other metabolic conditions Gout
What are the investigations for pseudogout?
Arthrocentesis- look at crystals under polarized red light and will see rhomboid shaped crystals (positively bi-refringent) Serum PTH and calcium Iron studies Magnesium levels X-ray-may see calcification on the joint
What is the management of pseudogout?
Intra-articular steroids Colchicine Systemic steroids NSAIDs Pseudogout is more like an arthritis than gout so will have bony changes and joint involvement so will need to manage this in conjunction
What is the management of pseudogout?
Painful joints Red and swollen joints Malaise Effusion Fever
