Gout Flashcards
Gout is caused by s_____ u____ crystals depositing along joint and intrarticularly
sodium urate
Gouty t____ are subcutaneous uric acid deposits typically seen on the hands, elbows and ears.
tophi
True or false: Gout is the most inflammatory arthritis in the UK?
True
What are risk factors for gout?
Male
Purine rich foods: meat, seafood
Beer
CVD
CKD
Diuretics
Obesity
Family history
What enzyme converts purines to uric acid?
xanthine oxidase
Increased uric acid or CKD both impair excretion, therefore higher levels of m_______ urate
monosodium
What are symptoms of gout?
Monoarticular, typically big toe (metatarsophalangeal joint)
Sudden onset
Severe, swollen, red toe
Can’t put weight on
What condition is similar but doesn’t have the same sudden onset?
Septic arthritis
What will the urate levels be in someone presenting with gout?
Normal.
The excess uric acid is now in crystal form in the joint. Levels would have been raised a few days before.
How do you diagnose gout?
Joint aspirate
Polarised light microscopy
Will show negatively birefringent, needle shaped crystals.
How do you treat acute gout?
1st line = Use NSAIDs like naproxen (co-prescribed with PPI)
2nd line = colchicine.
3rd line = steroids
What are common side effects of colchicine?
Abdominal symptoms and diarrhoea.
Very dangerous in overdose, can cause multiple organ failure
How do you manage gout longer term?
Decrease purines from diet
Increase dairy
Take allopurinol (xanthine oxidase inhibitor to decrease uric acid production)
Stay hydrated
What would an X-ray of a joint affected by gout show?
Maintained joint space
Lytic lesions in the bone
Punched out erosions with sclerotic borders and overhanging edges
True or false: once allopurinol is initiated, it is continued during an acute attack
True
