Gout

Question 1

Gout in general, clinical presentation, crystal shape, etc

Answer 1

• overproduction of Uric acids (>6.8 )
• associated with hypertension and obesity
• often in 1st MTP, forefoot and ankle
• intracellular and extracelluar, neg. birefringement, Needle shaped crystals
• think yellow, Parallel, allopurinol
• tophi, renal calculi, olecranon bursitis
• mainly in men

Question 2

Pseudogout in general - clinical presentation, crystals, location

Answer 2

• Calcium pyrophosphate deposition disease
• associated with OA, hyperparathyroidism, hemohromatosis, hypophosphatemia, osteodystrophy, wilson’s
• presents mainly in knees and wrists
• intracellular and extra, pos. birefringent rhomboid shaped
• looks fluffy white on X-ray - knee, wrist, pubic symphysis
• affects men and women

Question 3

Uric Acid Metabolism

Answer 3

Purine nucleotides/sides -> hypoxanthine -> (xanthine oxidase) -> Xanthine -> (xanthine oxidase) -> uric acid

Question 4

Drugs to inhibit the Uric Acid pathway

Answer 4

• Allopurinol blocks xanthine oxidase turning hypoxanthine to xanthine
• Febuxostat - prevents xanththine oxidase from xanthine to uric acid
• pegloticase - synthestic uricase to break down uric acid

Question 5

Gout treatment - acute and chronic

Answer 5

Acute 
	- NSAIDs, corticosteroids, Cholchicine (stop inflammasome), 
	IL-1 antagonist (Anakinra)
Chronic Gout
	- Uricosurics - block reuptake of uric acid (probenecid and 
	benzbromarone)
	-Xanthine oxidase inhibitor
	- Colchicine
	- Pegloticase - synthetic uricase

Question 6

PseudoGout (CPPD) treatment

Answer 6

Acute -
- NSAIDs, Corticosteroids, IL-1 anatgonists? Colchicine to prevent

CHronic
- NSAIDs, Colchicine