GOUT

Question 1

define GOUT

Answer 1

A type of arthritis where urate crystals are deposited in joints, and it is associated with high uric acid levels in the blood.

Question 2

what is GOUT characterised by

Answer 2

sudden, severe attacks of pain, swelling, redness, and tenderness in the joints.

Question 3

what is the most common inflammatory arthritis in the UK

Answer 3

GOUT

Question 4

non modifiable risk factors for GOUT

Answer 4

• Male sex
• Age >50
• Family history
• Overproduction of uric acid.

Question 5

modifiable risk factors for GOUT

Answer 5

• Obesity
• Hypertension
• CKD
• Diabetes
• High purine diet (meat and seafood)
• Medications (thiazides, ACEi, asprin)

Question 6

what is the impact of GOUT triggers

Answer 6

Gout has several triggers/precipitating factors that can cause an acute flare, usually due to production of uric acid.

Question 7

give 6 triggers for GOUT

Answer 7

• Seafood/protein binges
• Chemotherapy
• Trauma and surgery
• Alcohol excess (PURINES)
• Intercurrent illness
• Medications (interfere with uric acid)

Question 8

signs and symptoms of gout

Answer 8

• Excruciating, sudden, burning pain in the affected joint
• Swelling, redness, warmth, and stiffness in the affected joint
• Asymmetric joint distribution
• Mild fever
• Tachycardia (sympathetic response to an acute attack)

Question 9

which food is anti GOUT

Answer 9

dairy

Question 10

does GOUT affect one joint or multiple

Answer 10

one - it is monoarticular

Question 11

how is monosodium urate formed

Answer 11

purines –> uric acid –> monosodium urate

Question 12

which joint does gout most commonly affect

Answer 12

the base of the big toe - metatarsophalangeal joint

Question 13

other jounts commonly affected by gout

Answer 13

• wrists
• bases of thumb (carpometacarpal joints)

Question 14

give 4 investigations for gout

Answer 14

1. joint aspirate
2. serum uric acid level
3. x rays
4. ultrasound

Question 15

what does joint aspiration & polarised light microscopy for gout show

Answer 15

• needle like negative birefringent crystals
• monosodium urate crystals
• no bacterial growth

Question 16

what does serum uric acid level show for gout

Answer 16

high level indicates diagnosis

Question 17

what does x ray of affected joint for gout show

Answer 17

punched-out erosions

Question 18

what does ultrasound of affected joint for gout show

Answer 18

double-contour sign

Question 19

first line treatment for acute flares of gout

Answer 19

NSAIDS (+PPI) - FIRST LINE

Question 20

second line treatment for acute flares of gout

Answer 20

Colchicine - SECOND LINE

Question 21

third line treatment for acute flares of gout

Answer 21

Oral Steroids - THIRD LINE

Question 22

3 ways to prevent gout

Answer 22

1. Xanthine oxidase inhibitors (lower the uric acid levels)
   
   • Allopurinol
   • Febuxostat
2. Medication reviews (some may cause hyperuricaemia)
3. Lifestyle changes/avoiding triggers can also reduce the risk of gout.

Question 23

which patients is colchicine given to

Answer 23

those who cannot have NSAIDS

Question 24

side effect of colchicne

Answer 24

diarrohea

Question 25

which dietary changes reduce gout risk

Answer 25

reduce purines, increase dairy

Question 27

what causes GOUT

Answer 27

the accumulation of monosodium urate crystals in and around the joints.