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Flashcards in Crystal Arthropathies Deck (46):
1

What is gout?

An acute monoarthropathy caused by defective uric acid metabolism

2

Where do more than 50% of gout cases manifest?

The metatarsophalangeal joint of the big toe

3

Where do the rest of gout cases manifet?

The smaller joints, ie the elbow and knee then distally

4

Can gout be polyarticular?

Yes

5

What is deposited in the joints in gout?

Monosodium urate crystals

6

What can cause an attack of gout?

Trauma/surgery
Starvation
Infection
Diuretics
Alcohol

7

Is gout more common in men or women?

M>F ~4:1

8

What is it important to do when suspecting gout?

********Exclude septic arthritis!!!!********

9

Differentials for gout?

Reactive arthritis
Haemarthrosis
CPPD
Palindromic RA

10

How can risk factors for gout be divided, broadly speaking?

Causes of reduced urate excretion
Causes of excess urate production
Co-morbidites

11

What causes decreased urate excretion?

Increasing age
Male/post menopausal
Impaired renal function
HTN
Metabolic syndrome
Diuretics
Drugs - aspirin, antihypertensives

12

What causes excess urate production?

Diet - alcohol, sweeteners, red meat, seafood
Genetic disorders
Psoriasis
Myelo- and lympho- proliferative disorders
Drugs - warfarin, cytotoxins

13

What do-morbidities are associated with increased risk of gout?

CVS disease
DM
HTN
CKD

14

If we suspect gout, and aspirate the joint, how should we image the crystals to confirm the diagnosis?

Polarised light microscopy

15

What characteristics do gout crystals have on polarised light microscopy?

Negatively bifringent and needle shaped

16

Do we see changes on X-ray of a joint with gout? If so, what?

No initial bony changes (soft tissue swelling only)

Later on may see punched out regions in juxta-articular bone, and loss of joint space

17

How is an acute episode of gout treated?

High dose NSAID

18

When would colchicine be used for an acute gout episode, and why isn’t it first line?

If high dose NSAIDs are contraindicated.

It takes longer to achieve the same relief.

19

What conservative management should come alongside medical treatment of gout?

Rest and elevate the joint
Ice packs

20

When might we use injected steroids to treat gout?

If both NSAIDs and colchicine are contraindicated e.g. severe renal impairment

21

When should we start prophylaxis for gout?

If a pt has:
-more than one attack in 12 months
-renal stones
-tophi

22

What prophylaxis do we use for gout?

Lifestyle changes - weight loss; avoid alcohol, red meat, and prolonged aspirin.
Medical intervention - allopurinol

23

How is allopurinol started? Why?

Titrated up from 100mg/24 hrs every 4 weeks to a maximum of 300mg/8 hrs, aiming for serum urate below 0.3mmol/L.

After an acute episode, cover with an NSAID or cochicine for up to 6 weeks/months respectively.

Can trigger an episode of gout

24

What are the potential side effects of allopurinol?

Fever, rash, decreased WCC

25

What is CPPD?

Calcium pyrophosphate deposition

26

Is CPPD acute or chronic?

It can be both!

27

Tell me about acute CPPD...

Acute monoarthropathy of larger joints in elderly.

Usually spontaneous, but triggered by illness/surgery/trauma

28

Tell me about chronic CPPD...

RA-like polyarthritis and synovitis

29

If a CPPD filled joint is aspirated and imaged, how is it done and what does it look like?

Polarised light microscopy

Weakly positively bifringent crystals, rhomboid shaped

30

What is another name for CPPD?

Pseudogout

31

How is pseudogout managed?

Acute - cool pack, rest, aspiration, IA steroids.
Chronic - consider methotrexate and hydroxychloroquine

32

How is an acute episode of gout treated?

High dose NSAID

33

When would colchicine be used for an acute gout episode, and why isn’t it first line?

If high dose NSAIDs are contraindicated.

It takes longer to achieve the same relief.

34

What conservative management should come alongside medical treatment of gout?

Rest and elevate the joint
Ice packs

35

When might we use injected steroids to treat gout?

If both NSAIDs and colchicine are contraindicated e.g. severe renal impairment

36

When should we start prophylaxis for gout?

If a pt has:
-more than one attack in 12 months
-renal stones
-tophi

37

What prophylaxis do we use for gout?

Lifestyle changes - weight loss; avoid alcohol, red meat, and prolonged aspirin.
Medical intervention - allopurinol

38

How is allopurinol started? Why?

Titrated up from 100mg/24 hrs every 4 weeks to a maximum of 300mg/8 hrs, aiming for serum urate below 0.3mmol/L.

After an acute episode, cover with an NSAID or cochicine for up to 6 weeks/months respectively.

Can trigger an episode of gout

39

What are the potential side effects of allopurinol?

Fever, rash, decreased WCC

40

What is CPPD?

Calcium pyrophosphate deposition

41

Is CPPD acute or chronic?

It can be both!

42

Tell me about acute CPPD...

Acute monoarthropathy of larger joints in elderly.

Usually spontaneous, but triggered by illness/surgery/trauma

43

Tell me about chronic CPPD...

RA-like polyarthritis and synovitis

44

If a CPPD filled joint is aspirated and imaged, how is it done and what does it look like?

Polarised light microscopy

Weakly positively bifringent crystals, rhomboid shaped

45

What is another name for CPPD?

Pseudogout

46

How is pseudogout managed?

Acute - cool pack, rest, aspiration, IA steroids.
Chronic - consider methotrexate and hydroxychloroquine