Podcast
Questions and Answers
What is a common physical manifestation of chronic tophaceous gout?
What is a common physical manifestation of chronic tophaceous gout?
Which of the following is considered a primary cause of gout due to overproduction?
Which of the following is considered a primary cause of gout due to overproduction?
Which condition is commonly differentiated from acute gout through synovial fluid analysis?
Which condition is commonly differentiated from acute gout through synovial fluid analysis?
What is an appropriate first-line treatment option for acute gout if there are no contraindications?
What is an appropriate first-line treatment option for acute gout if there are no contraindications?
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What dietary component is specifically encouraged to be avoided to manage gout?
What dietary component is specifically encouraged to be avoided to manage gout?
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Which of the following is NOT an indication for urate lowering treatment in gout management?
Which of the following is NOT an indication for urate lowering treatment in gout management?
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Which urate lowering drug does NOT require dose reduction in cases of renal impairment?
Which urate lowering drug does NOT require dose reduction in cases of renal impairment?
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What factor is most closely associated with underexcretion in the pathophysiology of gout?
What factor is most closely associated with underexcretion in the pathophysiology of gout?
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In the treatment of chronic gout, which lifestyle modification is specifically recommended?
In the treatment of chronic gout, which lifestyle modification is specifically recommended?
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How should colchicine be administered in patients with acute gout?
How should colchicine be administered in patients with acute gout?
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Study Notes
Crystal-Associated Arthritis
- Gout
- More common in males
- Can occur in older men, but younger men can also be affected
- Associated with ankylosing spondylitis in some cases
- Causes of Gout
- Overproduction of uric acid
- Acquired
- Dietary factors (hematological, psoriatic, chemotherapy diseases)
- Inherited
- Underexcretion of uric acid
- Renal (90%)
- Combination of overproduction and underexcretion
- Alcohol is a contributing factor
- Uric acid overproduction/underexcretion
- Overproduction of uric acid
Stages of Gout
- Asymptomatic hyperuricemia: no need for treatment
- Acute gout
- Intercritical period: Asymptomatic periods between attacks
- Chronic tophaceous gout: Deformities and bone erosions
- Punched-out appearance with overhanging edges
- Acute gout presentation: Acute monoarthritis (commonly in the first metatarsophalangeal joint)
- Differential diagnosis (DDX): Septic arthritis (differentiation through synovial fluid aspiration with polarized microscopy)
- Findings on microscopy: Needle-shaped, negatively birefringent crystals
- Treatment of acute gout
- NSAIDs (if no contraindications)
- Colchicine (contraindicated in renal impairment and statin use)
- Steroids (avoid in DM)
- Local steroid injection
- Anakinra (IL-1 agonist)
Treatment of Chronic Gout
- Lifestyle modification (diet)
- Urate-lowering drugs (5 indications)
- Education
- Correction of predisposing factors
- Avoiding hyperuricemic drugs
- Thiazide diuretics
- Loop diuretics (furosemide)
- Niacin (B3)
- Low doses of aspirin
- Foods to avoid
- All meats
- Seafood
- Meat extracts
- Yeast extracts
- Beans
- Lentils
- Peas
- Oats
- Spinach
- Asparagus
- Cauliflower
- Mushrooms
Indications for Urate-Lowering Treatment (ULT)
-
Frequent flares (more than 2-3 flares per year)
-
Renal stones
-
Tophaceous gout (detected on radiographs)
-
Moderate-to-severe CKD
-
Evidence of bone or joint damage
-
The risk of flares can be reduced by using prophylaxis like NSAIDs during the first few months following diagnosis
Urate-lowering drugs
- Allopurinol (available and cheap)
- Febuxostat (no need for dose reduction, Hypersensitivity reaction possible)
- Side effects of Allopurinol (Xanthine oxidase inhibitors)
- Dose Reduction due to renal function test (RFT)
- Uricosuric drugs
- Contraindicated in renal stones and overproducers/renal impairment.
- Uricase (IV)
- Pegloticase (expensive and used in refractory cases)
CPPD (Chondrocalcinosis)
- Causes
- Idiopathic, closely related to osteoarthritis (OA)
- Genetic mutation (early onset CPPD)
- Secondary to other conditions
- Hyperparathyroidism
- Hypothyroidism
- Lipomaquesemia
- Hypophosphatemia
- Hemochromatosis
- Wilson's disease
- Presentation
- Asymptomatic
- Acute pseudogout (most common)
- Chronic pseudo-RA (knee and wrist, monoarticular in 89%)
- Chronic pseudo-OA
- Diagnosis
- Synovial fluid aspiration under polarized microscopy (Rhomboid shape and positive birefringence)
- X-ray shows chondrocalcinosis (calcium pyrophosphate deposition)
- Knee meniscus
- Wrist triangular
Treatment of Pseudogout
-
Same as acute gout treatment, plus treatment of the underlying cause
-
NSAIDs (if no contraindications)
-
Colchicine (not given in renal impairment and statin use)
-
Steroids (avoid in DM)
-
Local steroid injection(s)
-
Anakinra (IL-1 agonist)
-
Problem in pseudogout: Calcium not uric acid
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Description
This quiz explores the fundamentals of gout and its association with crystal-related arthritis. It covers causes, stages, and distinguishing features of gout, including its prevalence and links to other conditions. Test your understanding of this common and complex condition.
