Podcast
Questions and Answers
What is the most common cause of gout related to uric acid levels?
What is the most common cause of gout related to uric acid levels?
Which of the following medications is contraindicated for patients with renal impairment?
Which of the following medications is contraindicated for patients with renal impairment?
Which dietary item should be avoided by individuals with gout?
Which dietary item should be avoided by individuals with gout?
What defines the chronic tophaceous stage of gout?
What defines the chronic tophaceous stage of gout?
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What is the primary reason for using urate lowering treatment in gout?
What is the primary reason for using urate lowering treatment in gout?
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Which of the following is a common presentation during an acute gout attack?
Which of the following is a common presentation during an acute gout attack?
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Which is a potential side effect of Allopurinol?
Which is a potential side effect of Allopurinol?
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What is the recommendation for alcohol consumption in patients with gout?
What is the recommendation for alcohol consumption in patients with gout?
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Which of the following statements about acute gout treatment is accurate?
Which of the following statements about acute gout treatment is accurate?
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What is a common misbelief regarding the treatment of chronic gout?
What is a common misbelief regarding the treatment of chronic gout?
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Study Notes
Crystal Associated Arthritis
- Gout is more common in males, often in older age
- Gout is associated with ankylosing spondylitis in younger males
- Causes of Gout:
- Overproduction of uric acid
- Acquired (due to diet)
- Inherited
- Underexcretion of uric acid
- Renal (90%)
- Combination
- Alcohol contributes to uric acid overproduction and underexcretion
- Overproduction of uric acid
Gout Stages
- Asymptomatic hyperuricemia (no treatment needed)
- Acute gout, marked pain, and inflammation, particularly in the big toe joint
- Intercritical period (between acute attacks), asymptomatic
- Chronic tophaceous gout, joint deformity, and erosion
Acute Gout Treatment
- NSAIDs (nonsteroidal anti-inflammatory drugs)
- Colchicine; contraindicated in patients with renal impairment and statin use
- Steroids, avoid in patients with kidney disease
- Local steroid injection
- Anakinra (IL-1 antagonist)
Foods to Avoid
- All meats
- Seafood
- Meat extracts
- Yeast extracts
- Beans
- Lentils
- Peas
- Oats
- Spinach
- Asparagus
- Cauliflower
- Mushrooms
Urate Lowering Treatment
- Indications: Frequent flares (more than 2-3 in a year), renal stones, tophaceous gout, moderate to severe kidney disease, bone or joint damage.
- Urate lowering drugs:
- Allopurinol is available and inexpensive.
- Febuxostat (no need dose reduction).
- Side effects: Hypersensitivity reaction.
- Uricase drugs: pegloticase; expensive and used in refractory cases
- Contraindications for some medications: renal stones and overproduction and renal impairment
CPPD (Calcium Pyrophosphate Deposition Disease)
- Idiopathic or closely related to osteoarthritis.
- Genetic mutations (early onset CPPD).
- Secondary causes: primary hyperparathyroidism, hypothyroidism, hyperlipoproteinemia, hypophosphatemia, hemochromatosis, Wilson's disease.
- Presentation:
- Asymptomatic
- Acute pseudo gout (more common in the knee and wrist)
- Chronic pseudo RA (knee and wrist, monoarticular, 89%)
- Chronic pseudo OA
- Diagnosis: synovial fluid aspiration under polarized microscope, reveals rhomboid shape crystals with positive birefringence
- X-ray: chondrocalcinosis in knee and wrist
- Treatment: Same as gout treatment plus treating the underlying cause.
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Description
This quiz covers essential aspects of gout, including its causes, stages, and treatment options. It highlights the connection between gout and conditions like ankylosing spondylitis, as well as dietary recommendations. Test your knowledge about managing and preventing this form of arthritis.
