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Flashcards in FN: Gout Deck (15):
1

Pathophysiology

- Deposition of monosodium urate crystas in an around joints - erosive arthritis
- may be precipitate by surgery, infection, fasting or diuretics

2

Presentation

- M>F = 5:1
- Acute monoarthritis with severe joint inflammation
- Also: assymetric oligoarthritis
- urate depositions in pinna and tendons =Tophi
- Renal disease: radiolucent stones and interstitial nephritis

3

Podagra

60% occur @ great toe MTP
Also ankle, foot, hand joints, wrist, elbow, knee

4

Differential

- septic arthritis
- Pseudogout
- Haemarthrosis

5

Causes

1. Hereditary
2. Drugs: diuretics, NSAIDS, cytotoxics, pyrazinamide
3. Reduced excretion: primary gout, renal impairment
4. Raised cell turnover: lymphoma, leukaemia, psoriasis, haemolysis, tumour lysis syndrome
5. EtOH excess
6. Purine rich foods, beef, pork, lamb, seafood

6

Associations

HTN
IHD
Metabolic syndrome

7

Investigations

1. Polarised light microscopy: negatively birefringement needle-shaped crystals
2. Raised serum urate (may be normal)
3. X-ray changes occur later

8

X-ray changes

- punched-out erosions in juxta-articular bone

9

Acute Rx

1. NSAID: diclofenac or indomethacin (strong NSAID)
2. Colchicine
- NSAIDS CI: warfarin, PUD, HF, CRF
- SE: diarrhoea
3. In renal impairment: NSAIDS and colchicine are CI - use steroids

10

Prevention conservative

Lose wt.
Avoid prolonged fast and EtOH excess

11

Prevention medical

1. Xanthine oxidase inhibitors: Allopurinol
2. Uricosuric drugs
3. Recombinant urate oxidase

12

Xanthine oxidase inhibitos
Use and SE

- Use if recurrent attacks, tophi or renal stones
- Introduce with NSAID or colchicine cover for 3/12
- SE: rash, fever, reduced WCC (with azathioprine)

13

Uricosuric drugs

Probenecid, losartan
Rarely used

14

Recombinant urate oxidase

Rasburicase
- May be used pre-cytotoxic therapy

15

When to start allopurinol

If patient has 2 attacks in a 12 month period

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