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Gout - Coggle Diagram
Gout
• Key findings from
history and examination
Presence of risk factors:
older age
conditions with high cell turnover rate
rapid onset severe pain
joint stiffness
most commonly joints are in the feet, especially the first metatarsophalangela, tarsometatarsal and ankle joints
pattern is usually 1 joint or less than 4
swelling and joint effusion
tenderness
tophi
may be present over extensor surface joints,
elbows , knees, achilles
differential diagnosis
Pseudogout
more likely to affect wrist and knee
Septic arthritis
Trauma
fewer inflammatory signs
RA
Reactive arthritis
commonly affects weight bearing joints
psoriatic arthritis
Hx of psoriasis
management
ACUTE
NSAIDS
2nd corticosteroids
Ongoing
Allopurinol
reduces production of uric acid
plus NSAID
Reduce risk factors
• Prognosis
and complications
Acute uric acid nephropathy
nephrolithiasis
(kidney stones)
Prognosis
painful and debilitating but self limiting
risk of recurrence high if not treated with
uric acid lowering agent
Epidemiology
prev around 1%
Men > Women
Aetiology
Risk factors for hyperuricaemia:
seafood
meat
alcohol
esp beer
diuretics
-obesitry, insulin resistance and BP
Hyperuricaemia is due to renal under-excretion of crate in 90% of cases
Investigations
artharocntesis with synovial fluid analysis
(synovial fluid microscopy)
Monosodium urate crystals
(needle-shaped crystals -ve for birefringence)
Serum uric acid level
P
Deposition of uric acid crystals in synovial of joints causing acute inflammation
hyperuricaemia