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Year 3 Rheumatology > Gout > Flashcards

Flashcards in Gout Deck (17)
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1
Q

Pathophysiology

A

Deposition of monosodium urate crystals in and around joints → erosive arthritis

May be precipitated by surgery, infection, fasting or diuretics

2
Q

Common joints

A

Big toe MTP 60%

Ankle, foot, hand joints, wrist, elbow, knee

3
Q

Presentation

A
  • M>F=5:1
  • Acute monoarthritis with severe joint inflammation
  • Asymmetric oligoarthritis
4
Q

Tophi

A

Urate deposits in pinna and tendons

5
Q

Associated conditions

A

Renal disease: radiolucent stones and interstitial
nephritis

HTN
IHD
Metabolic syndrome

6
Q

Causes of gout

A

Hereditary
Drugs: diuretics, NSAIDs,
↓ excretion: renal impairment
↑ cell turnover: lymphoma, leukaemia, psoriasis,
haemolysis
EtOH excess
Purine rich foods: beef, pork, lamb, seafood

7
Q

Ix of gout

A
Joint examination 
Basic obs 
Bloods: FBC, Urate (may be normal)
Polarised light microscopy
- Negatively birefringent needle-shaped crystals
8
Q

X-ray changes

A

Signs occur late

  • Punched-out erosions in juxta-articular bone
  • ↓ joint space
9
Q

Mx

A

NSAID: diclofenac or
Colchicine

In renal impairment: NSAIDs and colchicine are CI
→ Use steroids

10
Q

Preventions

A

Conservative:

  • Lose wt.
  • Avoid prolonged fasts and EtOH excess

Xanthine Oxidase Inhibitors: Allopurinol

  • Use if recurrent attacks, tophi or renal stones
  • Introduce with NSAID or colchicine cover for 3/12

Uricosuric drugs: e.g. losartan
(Rarely used)

11
Q

Allopurinol allergy

A

Use febuxostat (XO inhibitor)

12
Q

Pseudogout

A

Arthritis that results from deposits of calcium pyrophosphate crystals

13
Q

Presentation of pseudogout

A

Causes pain, stiffness, tenderness, redness, warmth and swelling (inflammation) in normally one joint

Usually knee, hip or wrist

14
Q

RF for pseudogout

A
↑ age
OA
DM
Hypothyroidism
Hyperparathyroidism
Hereditary haemochromatosis
Wilson’s disease
15
Q

Gout Polarised light microscopy results

A

Negatively birefringent needle-shaped crystals

16
Q

Pseudogout polarized light microscopy

A

Positively birefringent rhomboid-shaped crystals

17
Q

Mx of pseudogout

A

Analgesia
NSAIDs
May try steroids