Condition Info - BotMed Application

ConditionName

Gout

ConditionDescription

Defect in urate metabolism from overproduction of urates or underexcretion

Symptoms

Sudden excruciating pain, redness, tenderness of big toe at night after binge drinking with beer; Fever; Can affect ankles, feet, knees; MTP most affected

PhysicalFindings

Red, hot, swelling joints (big toe);
Infected joint has redness, warmth, and tenderness;
Tap joint to exclude infection

ClinicalTests

High uric acid;

Most accurate: aspiration of affected joint (needle shaped crystals with negative birefringence on polarized light microscopy);

2000-50000 WBC (neutrophils);

During ACUTE stage: ESR and leukocytosis elevated;

Uric acid (95%) elevated. Not good for R/O;

Test result of protein, glucose of synovial fluid don’t help for Ddx;

xRay normal in acute gout, later erosion. 
Arthrocentesis;

RiskFactors

90% male;
Renal dz;
Obesity;
Excessive consumption of purine-rich food (organ meat, seafood, alcohol);
Cancer;
Drugs: Diuretics, Cyclosporine; cancer drugs and radiation;

IsRedFlag

IsNPLEX

Consequence

Chronic gout: Tophi: tissue deposition of urate crystals with foreign body reaction

Most common occur on cartilage, subcutaneous tissues, bone, kidney

Take years to develop

Uric acid stones: 5-10% of pts

ProgressionFromCondition

Long asymptomatic periods are common; 
Overproduction:
Idiopathic;
Increased cell turnover b/c or hemolysis, cancer, psoriasis, chemo);
Polycythemia Vera
Enzyme deficiency.

Underexcretion:
Renal insufficiency;
Ketoacidosis, lactic acidosis;
Use of thiazides or ASA.

TreatmentOptions

PharmOptions

NSAIDs superior – best initial therapy for acute;
Steroid injection if fine for 1 joint!

Chronic gout:
Decrease consumption of alcohol, particularly beer.
Weight lose;
Decrease high purine foods;
Stop thiazides, ASA, niacin

Colchicine helps to prevent second gout attack;

Allopurinol decreases production of uric acid;

AE of the treatment:
Hypersensetivity (rash, hemolysis, allergic nephritis)occurs with allopurinol

Do not START allopurinol during ACUTE attack of gout! But you can continue it.

WebLink

https://www.merckmanuals.com/en-ca/professional/musculoskeletal-and-connective-tissue-disorders/crystal-induced-arthritides/gout