Gout and Crystal Arthritis Overview

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Questions and Answers

What is the most common cause of gout related to uric acid levels?

  • Underexcretion from renal issues (correct)
  • Overproduction due to lifestyle choices
  • Combination of diet and inherited factors
  • Inherited metabolic disorders

Which of the following medications is contraindicated for patients with renal impairment?

  • Allopurinol
  • Colchicine (correct)
  • Ibuprofen
  • Anakinra

Which dietary item should be avoided by individuals with gout?

  • Eggs
  • Milk
  • Rice
  • Spinach (correct)

What defines the chronic tophaceous stage of gout?

<p>Deformities and bone erosions (D)</p> Signup and view all the answers

What is the primary reason for using urate lowering treatment in gout?

<p>Prevention of acute attacks (C)</p> Signup and view all the answers

Which of the following is a common presentation during an acute gout attack?

<p>Acute monoarthritis in the first MTP joint (C)</p> Signup and view all the answers

Which is a potential side effect of Allopurinol?

<p>Hypersensitivity reactions (C)</p> Signup and view all the answers

What is the recommendation for alcohol consumption in patients with gout?

<p>Alcohol should be completely avoided (C)</p> Signup and view all the answers

Which of the following statements about acute gout treatment is accurate?

<p>NSAIDs are generally safe for managing acute attacks (D)</p> Signup and view all the answers

What is a common misbelief regarding the treatment of chronic gout?

<p>Avoiding hyperuricemic drugs is beneficial (B)</p> Signup and view all the answers

Flashcards

Gout Prevalence

Gout occurs more frequently in men than women, particularly as they age. It's also a common condition that affects men at a younger age, while ankylosing spondylitis is more common in young men.

Overproduction of Uric Acid

One of the causes of gout is overproduction of uric acid. This can be due to a variety of factors including diet, underlying disease, or inherited tendencies.

Underexcretion of Uric Acid

Another cause of gout is impaired excretion of uric acid, primarily due to kidney dysfunction. This occurs in about 90% of cases.

Combined Overproduction and Underexcretion

The combination of overproduction and underexcretion of uric acid leads to a buildup in the body, contributing to gout.

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Asymptomatic Hyperuricemia

The asymptomatic stage of gout is characterized by elevated uric acid levels without any clinical symptoms.

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Acute Gout

The most common presentation of acute gout is sudden, severe inflammation of a single joint, often the big toe's first metatarsophalangeal joint.

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Intercritical Gout

The intercritical period is the symptom-free period between acute gout attacks.

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Chronic Tophaceous Gout

Chronic tophaceous gout is a severe form of gout characterized by tophi, or hard nodules, forming under the skin. This stage often leads to bone erosion and deformities.

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Gout Diagnosis

To differentiate gout from septic arthritis, synovial fluid analysis is conducted. Under a polarized microscope, needle-shaped, negatively birefringent crystals are indicative of gout.

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Acute Gout Treatment

NSAIDs are the primary treatment for acute gout, but they should be avoided in patients with contraindications. Colchicine is an alternative, but its use is limited in cases of kidney impairment and individuals on statins. Steroids and local injections can also provide relief. Anakinra, an IL-1 agonist, is another treatment option.

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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

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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