Gout Flashcards
(16 cards)
how does gout normally present
acute monoarthropathy with severe gout inflammation
what causes gout
deposition of mono-sodium urate crystals in or around the joint
what is gout associated with
high urate levels
describe the epidemiology of gout
males affected x4 more
give some dietary causes of raised urate
alcohol
sweeteners
red meat
seafood
what conditions is gout associated with
HTN
CVD
Diabetes
CKD
what joints are most commonly affected by gout
ankle foot small joints of the hand elbow knee
what joint in the foot is most commonly affected
metatarsophalangeal
give some things you might see on radiography
- joint effusion
- eccentric erosions
- well-defined “punched out” erosions
- relative preservation of joint space until later disease
- soft tissue tophi
what is some lifestyle advice and self care advice you can give to a patient with gout
- rest and elevate the limb
- avoid trauma to the affected limb
- keep joint exposed and in a cool environment
- consider use of an ice pack
lifestyle advice
- lose weight
- avoid alcohol and red meat
- exercise
- fluid intake
what is first line pharmacological management of acute gout
high dose NSAIDs (not aspirin) + PPI
colchicine
if a patient cannot tolerate NSAIDs, what can you use instead
oral corticosteroids or IM corticosteroids
what are some CI for NSAIDs
- active GI bleeding/GI ulcer
- hypersensitivity including asthma
- severe hepatic or renal impairment (eGFR <30)
how does allopurinol work
decreases blood uric acid
when should you offer allopurinol
should not be started for 2 weeks after an acute attack
what are the side effects of allopurinol
rash, fever, decreased WCC
