Gout

Question 1

What is podagra?

Answer 1

Acute inflammation of the 1st MTP joint with swelling, erythema, and tenderness

Question 2

What clinical situations would give rise to podagra?

Answer 2

1. Gout (or other crystal deposition dz like calcium pyrophosphate)
2. Infectious arthritis (acute and monoarticular)
3. Trauma
4. cellulitis

Question 3

What clinical features distinguish gout from rheumatoid arthritis?

Answer 3

RA: multiple joints, occurring over a longer time period. Both have nodules, but RA nodules are soft but firm (like an unripe fruit or lymph node) while gout nodules (aka tophi) are hard pebbles

Question 4

What clinical features distinguish gout from psoriatic arthritis?

Answer 4

Usually psoriatic arthritis will also show nail pitting or a rash

Question 5

What clinical features distinguish gout from osteoarthritis?

Answer 5

Osteo:Can affect the 1st MTP alone, but acuity and severity make this unlikely

Question 6

What test would you order in a patient with acute monoarticular arthritis?

Answer 6

ALWAYS ASPIRATE THE JOINT! Analyze the fluid for crystals and WBC and gram stain

Question 7

If you suspect gout, and draw a low uric acid level, what does that tell you?

Answer 7

Nothing. It could still be gout because uric acid decreases during an acute attack. If it’s high, then it is helpful in solidifying diagnosis

Question 8

When considering potential treatments for gout, what would you want to know about the patient?

Answer 8

Renal and liver function. Some treatments increase risk of nephrolithiasis

Question 9

Can you diagnose septic arthritis through blood cultures?

Answer 9

No. you need arthrocentesis as well.

Question 10

What other diagnostics would you want in a patient with podagra?

Answer 10

GET AN X-RAY! Make sure it’s not trauma

Question 11

What do gout crystals look like?

Answer 11

yellow when parallel to polarized light. negatively birefringent (blue when perpendicular to polarized light)

Question 12

What is pseudogout?

Answer 12

Calcium pyrophosphate crystals CPPD.

Question 13

What do CPPD crystals look like?

Answer 13

rhomboid shaped with opposite colorization to polarized light (i.e. yellow when perpendicular, blue when parallel) called a positive birefringence. Also, crystals are duller

Question 14

If you see no organisms on gram stain, what does this tell you?

Answer 14

Less likely to be infectious arthritis, but you should still do cultures of the fluid

Question 15

What are the X ray findings in gout?

Answer 15

punched out erosions.

Question 16

What are the causes of hyperuricemia?

Answer 16

Obesity
Aspiring
HCTZ
Ethanol
Fructose

Question 17

How do you treat acute gout?

Answer 17

NSAIDs in max dosing.

Question 18

What are contraindications to NSAIDs?

Answer 18

Impaired renal function, age, history of GI bleeding

Question 19

What do you treat gout with if not NSAIDs?

Answer 19

Colchicine. Give hourly or until diarrhea

Question 20

What is the safest option for treating acute gout in someone with CKD?

Answer 20

steroids

Question 21

How do you treat long term maintenance of gout?

Answer 21

allopurinol until serum uric acid is stop drinking alcohol, esp beer! Hops are bad
–>change in diet

Question 22

Should you treat asymptomatic hyperuricemia?

Answer 22

No.

Question 23

What long term therapy should help in gout?

Answer 23

Need to lower uric acid serum levels using allopurinol. Because changes in serum uric acid levels can precipitate a gout attack, need to prophylax in the first 1-6 months with colchicine.