Rheumatology Flashcards
Where do more than 50% of gout cases present?
Metatarsophalangeal joint
What kind of crystal deposits are found in gout?
Mono sodium urate crystals
Give some examples of things that can precipitate gout.
Trauma Surgery Starvation Infection Diuretics
What two main complications may arise from long term gout?
Urate deposits- tophi
And renal disease- stones, interstitial nephritis
4 differentials for gout
Septic arthritis
Haemarthosis
CPPD
Palindromic RA
What are the causes of gout?
Hereditary, increased Dietary purines (liver, kidney, sweetbreads, some seafoods), leukemia, diuretics, alcohol excess, cytotoxics(tumour lysis)
What are the four disease associations with gout?
Diabetes, chronic renal failure, cardiovascular disease, hypertension
What will polarised light microscopy show in gout?
Negatively birefringent urate crystals
What is the treatment for acute gout?
High dose NSAID or coxib (eg etoricoxib 120mg/24 h)
If CI: colchicine 0.5mg/6-12h P.O. (don’t give either in renal impairment!)
Steroids
Rest and elevate joint
Ice packs
Bed cages
What things can be done to prevent gout?
Lose weight Avoid purine rich foods Avoid alcohol excess No prolonged fasts Avoid low dose aspirin- increases serum urate
What is the prophylaxis treatment for gout?
Allopurinol- titration from 100mg/24 hr increasing every two weeks until plasma urate <0.3 mmol/L (max 300mg/8h)
Start if >1 attack in 12 months, tophi or renal stones
May trigger attack at introduction so only start 3 weeks after an acute episode and cover with regular NSAID (up to 6weeks) and colchicine (0.5mg/12h P.O. for up to 6 months )
What is given if allopurinol is contraindicated or not tolerated?
Febuxostat (80mg/24h)
Decreases Uric acid by inhibiting xanthine oxidase
What are the side effects of allopurinol?
Rash
Fever
decreased WCC
What is the full form of CPPD?
Calcium pyrophosphate deposition
What are the three patterns of CPPD?
Acute CPP crystal arthritis aka pseudo gout
Chronic CPPD
osteoarthritis with CPPD
