gout
| Close association with cardiovascular risk factors | |
|---|---|
| Etiology | Monosodium urate crystals forming in and around joints. Hyperuricaemia (CKD), drugs (Loop diuretics, thiazides, pyrazinamide), starvation, cytotoxics (Tumour lysis syndrome) |
| Epidemiology | M>F |
| Clinical presentation | Site: 1st metacarpal, base of thumb, ebow; pseudogout: wrist Pain++, redness, warmth - max intensity within 24h Previous self-limiting episodes supports diagnosis Tophi - extensor joint surfaces |
| Pathogenesis | |
| Diagnostic investigations | XR: periarticular erosions Joint aspirate: negatively birefringent needle-shaped crystals |
| Management | Acute mx: NSAIDs, colchicine PO, f/u after 4-6/52 • Colchicine s/e: diarrhoea (dose-dpdt) • Continue ULT if already established; continue diuretics in HF • Stage 5 CKD ⇒ steroids instead of NSAIDs Start urate-lowering therapy after acute attack resolves. - Allopurinol (xanthine oxidase inhibitor) or febuxostat (needs LFT monitoring)- usually lifelong. (s/e: rash, fever, ↓ WCC) - Co-prescribe with colchicine prophylaxis - Review CVS risk factors, lose weight. Monitoring: serum uric acid |
pseudogout = calcium pyrophosphate deposition
- same sites
- joint aspiration: positively birefringent rhomboid-shaped crystals
- can still use colchicine/NSAIDs