Gout Flashcards
(25 cards)
What causes gout?
Monosodium urate crystal deposition
Define gout
An acute inflammatory arthritis characterised by hyperuricaemia and deposition of urate crystals
Note: you don’t always have to have hyperuricemia
Which joints are primary affected in gout?
1st MTP Mid foot Ankle Knee Fingers Wrist Elbow Any joint
What is it called when it affects the 1st MTP?
Podagra
Epidemiology
Rare in pre-menopausal women
Being male is a risk factor
Signs
Tophi (visible depositions) Joint stiffness Swelling Tenderness Erythema Warmth
Aetiology
Older age
Male sex
Menopausal status
FOOD:
Consumption of meat, seafood, alcohol
DRUGS:
Use of diuretics, ciclosporin and tacrolimus, pyrazinamide, aspirin
(increased tubular reabsorption of urate and decreased GFR)
CONDITIONS: obesity exogenous insulin (reduces renal excretion of urate) HTN Renal insufficiency Diabetes mellitus Hyperlipidemia Leukemia Alcohol excess Polycythemia FH of gout
RECENT:
Surgery
Fasting
Chest infection
Investigations
Arthrocentesis for synovial fluid analysis Serum urate Xray Full FBC U and E LFTs CRP
Why do we look at LFT?
Alcohol excess can precipitate gout (due to tubular dysfunction)
Why do we do full FBCs?
Polycythemia and leukemia can precipitate gout
Why do we look at Us and Es?
To check for renal stones as hyperuricemia can result in this
What would an xray of the podagra show?
Punched out, bony erosion seen in relation to 1st MTP
Soft tissue swelling in relation to the 1st MTP
What do you expect to find in the aspiration?
Negatively birefringent crystals on microscopy
How do these crystals appear?
Yellow and needle shaped
First line treatment for acute gout
NSAIDS
If the patient can’t have NSAIDs due to e.g. a history of duodenal ulcer, what would you prescribe them?
Colchicine
SE of colchicine?
Diarrhoea
Vomiting
Long term therapy for chronic gout?
Allopurinol
How does allopurinol work?
It inhibits the xanthine oxidase enzyme which normally converts hypoxanthine to uric acid in the purine catabolism pathway.
Give one reason how alcohol could cause gout
Alcohol increases the acidity of the urine
Uric acid is a weak acid therefore
At normal physiological conditions, it only weakly ionises, so it stays more as urate
In strongly acidic urine, it is more likely to stay unionised as urate
Urate is strongly reabsorbed…
Precipitating gout !
Which foods and drinks should be avoided?
Red meat/bacon
Sardines
Alcohol
Sugary drinks
What would an xray of podagra show?
Punched out erosions
soft tissue swelling
tophi
Management
RICE Rest Ice Compression Elevation
Dietary advice
NSAIDS/colchicine/steroids - think PPI
Prophylaxis management
Allopurinol
