Gout Flashcards
1
Q
What is the definition of gout?
A
Defect in metabolism of uric acid causing arthritis
2
Q
How common is gout?
A
Prevalence of gout is 1.4%
3
Q
What is the pathophysiology of gout?
A
- > 50% occur at the metatarsophalangeal joint of the big toe
- Deposition of precipitated monosodium urate crystals in and near joints – less soluble under acid and low temperatures
- Due to too much uric acid/urate in the blood
- Urate deposits = tophi in pinna (outside the ear), tendons and joints
- Renal disease (stones and interstitial nephritis) may also occur
4
Q
What is the aetiology/risk factors for gout?
A
- Men
- Trauma
- Surgery
- Starvation
- Infection
- Diuretics
- Hereditary
- ↑ diet purines – meats mainly
- Alcohol
- Leukaemia
- CV disease
- Hypertension
- Diabetes
- Chronic renal failure
5
Q
What are the signs/symptoms of gout?
A
- Swollen
- Tender
- Erythematous
- Fever
- Malaise
- Difficulty using the affected joints
- Pressure ↑ pain exponentially
- Maximum pain after before 24 hours
- Tophi – draining or chalk like subcutaneous nodule under skin
6
Q
What diseases does gout present similarly to?
A
- Septic arthritis
- Haemarthrosis
- CPPD
- Palindromic RA
7
Q
What investigations would be needed to diagnose gout?
A
- ↑ plasma/serum urate
- Polarised light microscopy of synovial fluid – shows urate crystals
- 24h urine sample
- Fasting glucose
- Fasting lipids
- X-Ray: soft tissue swelling initially the well punched out erosions seen in bone
- US: double contour sign
8
Q
What are the pharmacological treatments for gout?
A
- High dose NSAID
- Colchicine
- Allopurinol – prevention
- Febuxostat – prevention
- Steroids – oral/IM/intra-articular
9
Q
What are the non pharmacological treatments for gout?
A
- Rest and elevate the affected joint – e.g. bed cage to keep foot elevated at night
- Ice packs
- Lose weight
- Avoid prolonged fasts
- Reduce alcohol consumption
- Reduce purine rich meats
