gout

Question 1

what is the pathophysiology of gout?

Answer 1

raised uric acid level in the blood
urate crystals get deposited in the joints leading to gouty arthritis and in other tissues eg soft connective, GUT

Question 2

what can cause build up of urate in the body?

Answer 2

decreased renal excretion eg CKD
overproduction eg myeloprofoliferative disorders, overconsumption of purine rich food that’s metabolised to urate

Question 3

what are the common purine rich foods that are metabolised to urate??

Answer 3

meat
seafood
oily fish
yeast products

Question 4

what are the risk factors for gout?

Answer 4

male gender 4:1
diet
alcohol
CKD
HTN
DM
sugary drinks
CHD, high triglycerides, HF
leech nyhan syndrome (x linked genetic condition that causes buildup of urate in body)

Question 5

what is the presentation of acute gout?

Answer 5

very painful red hot tender joint
most common = big toe
other common sites - small joints of foot (mid tarsal), hands, ankle, knee, elbow

Question 6

what is the presentation of chronic gout?

Answer 6

usually >1 joint
tophi (subcutaneous depiction of crystals u can see)
uric acid kidney stones
fever and malaise (rare)

Question 7

what bloods do you do for gout?

Answer 7

serum urate - high but may fall during an acute attack
fasting glucose and lipids - gout is often associated with metabolic disorder

Question 8

what do you see in synovial fluid analyses of gout ?

Answer 8

negatively bifringent crystals under polarised light microscopy

Question 9

what beyond investigations do you do for gout?

Answer 9

x ray
joint aspiration and synovial fluid analysis
can do US, CT, MRI