Crystal arthropathy Flashcards
Gout
Chronically high blood uric acid levels
Urate crystals deposited in the joint
Gouty tophi
Subcutaneous deposits of uric acid
Typically small joint and connective tissue of hands, elbows and ears
DIP joints most affected in hands
Presentation
Acute onset
Pain
Swelling
Erythema
Gout risk factors
Male
Obesity
High purine diet
Alcohol
Diuretics
Existing cardiovascular or kidney disease
FH
Typical joints for gout
MTP joint
Wrist
Base of thumb
Diagnosis
Clinical or fluid aspiration
Aspiration for gout
No bacterial growth
Needle shaped crystals
Negatively birefringent of polarised light
Monosodium urate crystals
Gout joint xrays
Joint space maintained
Lytic lesions
Punched out erosions
Erosions can have sclerotic borders with overhanging edges
Acute management of gout
NSAIDs first line
Colchicine second-line
Steroids third-line
Colchicine
In patients with renal impairment or significant heart disease
Causes GI upset and diarrhoea
Gout prophylaxis
Allopurinol reduces uric acid level
Lifestyle changes: lose weight, stay hydrated, minimise consumption of alcohol and purine-based foods
Gout prophylaxis
Allopurinol reduces uric acid level
Lifestyle changes: lose weight, stay hydrated, minimise consumption of alcohol and purine-based foods
