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Gout

Dr Swapnil Pawar November 8, 2021 15


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    Gout
    Dr Swapnil Pawar

Written by – Dr Andrew Lam

Gout vs. Pseudogout

Gout Pseudogout
Predominant Sites Affected Small Joints (i.e. 1st MTP) Large Joints (i.e. knee)
Clinical Findings Marked swelling, erythema and tenderness +/- tophi Swelling and tenderness often less marked than in gout
Pathophysiology Uric acid crystal deposition Calcium pyrophosphate crystal deposition
Microscopy Findings Negatively birefringent, needle-like crystals Positively birefringent, rhomboid crystals
Radiological Findings Lytic bony erosions with overhanging sclerotic margins

Tophi

Chondrocalcinosis

Subchondral cysts

 

Risk Factors for Gout

Non-Modifiable

  • Older age
  • Male

Modifiable

  • High purine diet 
  • Alcohol
  • Obesity
  • Hypertension
  • Diabetes Mellitus
  • Hypercholesterolaemia
  • Chronic Kidney Disease

Management of Gout

Acute Flare

Management of an acute gout flare is based on patient comorbidities and contraindications to potential therapy. Options can include:

  • NSAID’s (i.e. indomethacin)
  • Oral steroids (i.e. prednisone)
  • Colchicine
  • Intra-articular steroid injections

Urate Lowering Therapy

Urate lowering therapy can be used to prevent further gout glares. The initiation of urate-lowering therapy should be done after acute flares have resolved, as the therapy itself can precipitate an acute gout flare. Options to lower uric acid levels include:

Non-Pharmacological: 

  • Weight loss
  • Decrease alcohol intake
  • Decrease purine intake
  • Management of other risk factors (i.e. hypertension, hypercholesterolaemia, kidney failure)

Pharmacological:

  • Allopurinol (First line) 
  • Probenecid
  • Febuxostat

N.B. Low dose colchicine can be given prophylactically to prevent a flare when commencing urate-lowering therapy. 

References:

eTG Complete (2021). Gout. Therapeutic Guidelines. Retrieved 30th September 2021 from https://tgldcdp.tg.org.au.acs.hcn.com.au/viewTopic topicfile=gout&guidelineName=Rheumatology&topicNavigation=navigateTopic#toc_d1e232

Gaffo, A.L. (2021) Clinical manifestations and diagnosis of gout. UpToDate. Retrieved 30th September 2021 from https://www.uptodate.com.acs.hcn.com.au/contents/clinical-manifestations-and-diagnosis-of-gout

Rosenthal, A.K. (2021) Clinical manifestations and diagnosis of calcium pyrophosphate crystal deposition (CPPD) disease. UpToDate. Retrieved 30th September 2021 from https://www.uptodate.com.acs.hcn.com.au/contents/clinical-manifestations-and-diagnosis-of-calcium-pyrophosphate-crystal-deposition-cppd-disease

 

 

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