Orthopaedics PHSI N203F: Gouty Arthritis
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Orthopaedics PHSI N203F: Gouty Arthritis

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Questions and Answers

Which of the following is a modifiable risk factor for gout?

  • Older age
  • Obesity (correct)
  • Family history
  • Ethnicity

    • What is the male to female ratio for those at risk of gout?

  • 5:1
  • 20:1 (correct)
  • 1:1
  • 10:1

    • Which of the following factors can influence urate balance in the body?

  • Stress
  • Extreme exercise
  • Dietary factors
  • Chronic renal impairment (correct)

    • Which of these lifestyle choices is most likely to act as a trigger for the development of gout?

    <p>Diet high in purines</p> Signup and view all the answers

    How long can it take for gout to develop after exposure to triggers?

    <p>20-30 years</p> Signup and view all the answers

    What is gouty arthritis primarily classified as?

    <p>A crystal deposition disease</p> Signup and view all the answers

    Which group has the highest prevalence of gouty arthritis?

    <p>Older men</p> Signup and view all the answers

    In which decade of life does the peak onset of gouty arthritis typically occur?

    <p>50s</p> Signup and view all the answers

    What mechanism is primarily responsible for hyperuricemia in gouty arthritis?

    <p>Over-production of urate</p> Signup and view all the answers

    How likely is a patient to experience a second attack of gouty arthritis within a year after the first?

    <p>60%</p> Signup and view all the answers

    Which condition is NOT a potential cause of hyperuricemia leading to gouty arthritis?

    <p>Obesity</p> Signup and view all the answers

    Which type of joint is most commonly affected by gouty arthritis?

    <p>1st metatarsophalangeal joint</p> Signup and view all the answers

    What is the acute phase duration of gouty arthritis symptoms?

    <p>Less than 10 days</p> Signup and view all the answers

    Which treatment option is a non-pharmacological management for gout?

    <p>Rest</p> Signup and view all the answers

    Which of the following is NOT a clinical feature of gouty arthritis?

    <p>Joint stiffness in the morning</p> Signup and view all the answers

    What common time does gouty arthritis often occur?

    <p>Early morning</p> Signup and view all the answers

    During an acute gout attack, when does the maximum intensity of pain typically occur?

    <p>At 24 hours</p> Signup and view all the answers

    Which of the following management strategies is focused specifically on patient education?

    <p>Dietary advice</p> Signup and view all the answers

    What is the main characteristic of asymptomatic hyperuricaemia in comparison to gout?

    <p>It is more common than gout</p> Signup and view all the answers

    Which condition is NOT part of the chronic pathology of gout?

    <p>Septic arthritis</p> Signup and view all the answers

    When do gouty tophi typically appear after the initial gouty attack?

    <p>Around 12 years</p> Signup and view all the answers

    What is the trail of symptoms between acute gouty attacks referred to as?

    <p>Intercritical gout</p> Signup and view all the answers

    What symptom may occur during a polyarticular attack of gouty arthritis?

    <p>Presence of fever</p> Signup and view all the answers

    What tissue structures can be involved in gout pathology?

    <p>Joint and periarticular structures</p> Signup and view all the answers

    Which of the following describes an aspect of chronic gout?

    <p>Persistence of pain in some patients</p> Signup and view all the answers

    What is the main characteristic of acute gouty arthritis?

    <p>Intense joint pain and inflammation</p> Signup and view all the answers

    What type of joint disease is primarily classified as a degenerative joint disease?

    <p>Osteoarthritis</p> Signup and view all the answers

    Which of the following conditions is characterized by symmetrical joint involvement?

    <p>Rheumatoid arthritis</p> Signup and view all the answers

    Which condition primarily affects weight-bearing joints?

    <p>Osteoarthritis</p> Signup and view all the answers

    How does morning stiffness differ among osteoarthritis, rheumatoid arthritis, and gout?

    <p>Osteoarthritis exhibits morning stiffness lasting less than 30 minutes.</p> Signup and view all the answers

    What is a distinguishing feature of gout compared to other types of arthritis?

    <p>Characterized by acute flare-ups and sudden onset</p> Signup and view all the answers

    Which demographic is most likely to experience rheumatoid arthritis?

    <p>Women aged 40-50</p> Signup and view all the answers

    Which characteristic of osteoarthritis differentiates it from rheumatoid arthritis?

    <p>Osteoarthritis typically presents as a non-inflammatory condition.</p> Signup and view all the answers

    In which condition is joint involvement typically monoarticular?

    <p>Gout</p> Signup and view all the answers

    Study Notes

    Gouty Arthritis Overview

    • Definition: Inflammatory arthritis caused by monosodium urate (MSU) crystal deposition in joints due to hyperuricemia (elevated uric acid levels).
    • Hyperuricemia: A serum uric acid level above 6.8 mg/dL is a key feature.

    Epidemiology

    • Prevalence: Affects 1-4% of the population; most common inflammatory joint disease in men.
    • Age Factor: Peak onset typically occurs in the 50s, with prevalence plateauing after age 70.
    • Recurrence: Approximately 60% experience a second attack within one year; 80% within three years.
    • High Serum Urate: Levels exceeding 9 mg/dL increase the likelihood of flare-ups by three times within 12 months.

    Etiology and Risk Factors

    • Causes of Hyperuricemia: Over-production or under-excretion of urate can lead to gout.
    • Triggers: Include chronic kidney disease, hypertension, certain medications, alcoholism, obesity, and extreme exercise.
    • Risk Factors: Include older age, male sex (20:1 ratio), genetic predisposition, and dietary habits (purine-rich foods).
    • Modifiable risks: Hypertension, hyperlipidemia, diabetes mellitus, obesity, and alcohol consumption.

    Pathology

    • Stages of Gout:
      • Asymptomatic hyperuricemia: High urate without symptoms.
      • Acute gouty arthritis: Characterized by sudden, severe pain.
      • Intercritical gout: Time between acute attacks, can include persistent pain.
      • Tophaceous gout: Involves solid urate crystals leading to joint damage; tophi appear around 12 years post-initial attack.

    Clinical Features

    • Symptom onset: Symptoms develop rapidly, often within 24 hours, marked by severe pain, swelling, erythema, and increased temperature.
    • Articular Characteristics: Typically monoarticular, often affecting the big toe (1st MTPJ), with acute attacks often occurring at night.
    • Duration: Acute phases usually last less than 10 days, alternating with long periods of remission.

    Diagnosis

    • Urate Levels: Serum urate levels above threshold indicate gout but only a small percentage with elevated uric acid experience gout symptoms.
    • Differential Diagnosis (DDx): Includes septic arthritis, osteoarthritis, trauma, and cellulitis to rule out other conditions.

    Management

    • Acute Treatment: Focuses on resolving pain and inflammation within 10 days using pharmacological methods.
    • Chronic Management: Involves patient education on lifestyle modifications, dietary advice, and possibly pharmacotherapy for urate-lowering.
    • Non-Pharmacological: Rest, ice, and splinting recommended to relieve symptoms during acute attacks.

    Role of Physiotherapists

    • Physiotherapists play a crucial role in managing gout, emphasizing education, physical activity guidance, and pain management strategies.
    • Comparative Aspects:
      • Gout differs from osteoarthritis (degenerative) and rheumatoid arthritis (autoimmune) in terms of pathology, symmetry, and onset of symptoms.
    • Key differences:
      • OA is non-inflammatory and affects weight-bearing joints; RA is symmetrical and affects peripheral joints; gout is inflammatory and monoarticular.

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    Description

    This quiz focuses on the physiotherapy management of gouty arthritis, a common musculoskeletal dysfunction associated with rheumatic diseases. It covers definitions, epidemiology, etiology, pathology, diagnosis, clinical features, and management strategies. Engage with key concepts to enhance your understanding of this condition.

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