Gout

Question 1

Joint fluid aspiration shows

Answer 1

needle shaped negatively birefringent monosodium urate crystals under polarised light

Question 2

Uric acid

Answer 2

Check 2 weeks after attack

Question 3

XRAY

Answer 3

punched-out’ erosions with sclerotic margins in a juxta-articular distribution, often with overhanging edges
Soft tissue tophi

Question 4

Lifestyle modifications post-flare (3)

Answer 4

reduce alcohol intake and avoid during an acute attack

lose weight if obese

avoid food high in purines e.g. Liver, kidneys, seafood, oily fish (mackerel, sardines) and yeast products

Question 5

Acute management

Answer 5

NSAIDs or colchicine (SE: diarrhoea)

Question 6

When to avoid 1st line management of acute attack

Answer 6

When CKD, prescribe oral prednisolone instead

Question 7

When to start ULT

Answer 7

after their first attack of gout, wait until inflammation has settled

Question 8

What ALT to start

Answer 8

1st line Allopurinol + colchicine cover
2nd line Febuxostat

Question 9

Further considerations

Answer 9

Discontinue thiazides