you've gout to be kidding me Flashcards
what is gout
deposition of monosodium urate in areas with slow blood flow
crystals are deposited in the joints and periarticular tissue of the feet
tophi can form in chronic gout
basically a uric acid overload due to diet/kidneys
what can cause gout
hyperuraemia psoriasis alcohol diuretics renal impairment exercise - lactic acid inhibits uric acid secretion starvation dehydration
what are risk factors for gout
diet high in meat and sea food alcohol male smoking drinking post-menopausal women hypertension
how does gout present
extreme pain in joint - usually big toe
usually comes on overnight
red, shiny, swollen foot
what investigations do you do for gout
crystals are negatively birefringent X-ray CT aspirate affected joint - rule out sepsis sodium urate levels crystals are needle shaped
how can you manage gout
for an acute attack - NSAIDs, colchicine, steroids
lifestyle advice - diet, hydration
xanthine oxidase inhibitors to manage tophi - allopurinol
uricosuric agents - sulphinpyrazone
prophylaxis - allopurinol - don’t start until after 1st acute attack has gone.
what is pseudogout
deposits of calcium pyrophosphate dihydrate in joints
what causes pseudogout
trauma
UTI
chest infections
how does pseudogout present
usually an elderly lady with a sore knee
sae presentation as gout - almost impossible to differentiate
what investigations would you do for pseudogout
positively birefringent
X-ray - chondrocalcinosis
aspiration of joint
how do you treat pseudogout
NSAIDs
steroid injections
Colchocine
joint washout
No prophylaxis.
What is the treatment for gout?
acute - 1st line is NSAIDs, 2nd Line is colchicine, 3rd line is steroids.
Prophylaxis - allopurinol (decreases uric acid) - if prescribing wait until the acute gout is resolved after this it can be continued through acute phases.
What are the crystals in gout?
Monosodium urate - made from increased uric acid and sodium.
What are the x-ray changes in gout?
No loss of joint space, lytic lesions that hand over the erosion.
What are the x-ray changes in pseudo gout?
Calcium deposition line in between the joint space
changes similar to osteoarthritis
