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18 Cards in this Set
- Front
- Back
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What causes gout?
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Gout is an inflammatory arthritis caused by the deposition of monosodium urate crystals in a joint.
Crystals form because of under-excretion (90%) or overproduction of uric acid. |
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What are the risk factors for gout?
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Risk factors for gout include medications, alcohol use, obesity, hereditary predispoition (extremely common in individuals from Samoa and the Phillipines), and hyperuricemia - although not all of these patients develop gout.
Less common precipitants of gout include lead poisoning and tumor lysis syndrome seen during chemotherapy for various cancers. |
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What medications causes increases in uric acid?
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1. Diuretics (the most commonly used medications that trigger gout)
2. Low-dose aspirin 3. Cyclosporine 4. Niacin |
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What are common triggers for an attack in patients with a history of gout?
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Rapid changes in urate level can trigger gout.
These changes can be attributed to decreased uric acid secretion and fluid shifts. Therefore, physiologic stresses caused by surgery, trauma, medical illness and new medications (that decrease uric acid secretion) can trigger gout. Hospitalization triggers acute gout attacks in up to 85% of those with a history of gout. Physical activities such as running and long walks may precede gouty attacks in the first MTP joint. Occasionally, starting therapy with allopurinol precipitates or worsen a gouty attack. For this reason, allopurinol is not started during an acute attack. |
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What is the typical presentation of gout?
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Men, Monarticular, MTP.
The pain is great and is exacerbated by even minimal pressure of bed sheets on the join. Erythema and warmth of the affected joint are typical. The onset of pain is usually sudden and often involves only one joint. In older patients, it is common for gout to occur in joints with osteoarthritis. The ankle, foot or knee can be the site of acute gout. Hips and shoulders are hardly ever affected. |
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T or F: Men are much more commonly afflicted with gout than are women.
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True.
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The most common first site of involvement is at which joint?
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The MTP joint of the great toe (greater than 50% of initial gout attacks).
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In greater than 80% of cases, the first episode of gout is monarticular or polyarticular?
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Monarticular.
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What symptoms and signs do you see with a severe attack of gout?
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Common findings are:
1. fever 2. multiple joint involvement 3. tachycardia 4. high WBC **The patients are frequently misdiagnosed as having an infection. |
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How do I diagnose gout?
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WBCs and ESRs are usually elevated during acute attacks, but are nonspecific.
The diagnosis is made by aspirating the involved joint and examining the fluid under polarized microscopy. Urate crystals are needle-shaped or rod-shaped and are both intracellular in neutrophils and extracellular. They are strongly negatively birefringent when examined under compensated polarized microscopy. |
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Most patients with gout have a high uric acid level greater than ?
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7 mg/dL
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Occasionally, uric acid levels are depressed during an acute attack. What should you do after the gouty attack subsides?
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Recheck the uric acid level.
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In patients with an established diagnosis of gout and recurrent episodes, there is no need to tap the joint again unless clinical features suggest the possibility of what?
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The possibility of a septic joint (fever, chills, lack of response to gout therapy).
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What happens to patients with long-standing gout?
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Patients may have acute attacks separated by long symptom-free periods.
Gouty arthritis can also become chronic, with urate deposition in joints and perarticular tissues that can lead to chronic, destructive, deforming arthritis. |
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With chronic joint destruction in gout, what might you see on an xray?
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X-rays may show classic "rat-bite" erosions that look like punched out areas of bone loss with an associated overhanging rim of cortical bone.
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Gout crystals can precipitate in the subcutaneous tissues causing deforming tophi. Where are the most common sites for tophi?
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the digits and ears
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How should I treat an acute attack of gout?
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1. The mainstay of treatment is NSAIDS (indomethacin 50 mg tid)
**Be extremely careful to avoid using NSAIDS in patients with contraindications such as CHF, renal insufficiency, history of gastric or peptic ulcer disease, or allergy to aspirin/NSAIDS. The alternatives for treatment of acute gout are prednisone (5-7 day course) or joint injection with corticosteroids. |
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What about colchicine in the treatment of acute gout attacks?
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Treatment-dose colchicine should not be used in patients with renal insufficiency. Colchicine causes severe diarrhea at treatment doses and is the least attractive option for treating gout. It should not be given in treatment doses to patients with renal insufficiency.
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