February 09, 2009
Gout is one of the few arthritides that is reversible and curable with a few simple dietary/lifestyle changes and drugs.
Current Rheumatology Diagnosis and Treatment elegantly describes it like matches. With flare-ups, the "matches" in the joints light up and cause pain. They can be blown out by NSAIDs, made wet with colchicine and removed entirely with allopurinol. This metaphor is akin to the pathophysiology, with the "matches" representing uric acid crystals precipitating in joint space and lighting up when they get inflamed by the invasion of neutrophils.
On a more clinical note, here's some mnemonics to remember Gout:
A TIC ("thick") red, inflamed joint:
-Trauma, Infection, Crystals
ROPE in your ddx of arthritis:
RA, OA, Pseudogout/Psoriatic, Everything else (some crazy zebras: reactive/Reiter's, Still's, Hemochromatosis, Lupus, Lyme, Whipple's, Behcets, Ochronosis)
When tapping a joint, order 3C's for Synovial Fluid ("CCCnovial")
Cell Count, Culture, Crystals
Synovial glucose is not as sensitive as WBC count (>500-1000) for infection.
The aim for the management of chronic tophaceous gout is <6.0 mg/dL of serum uric acid.
Think: <6 to fix.
If the 24 hour urinary uric acid is >800, probenecid can be an alternative to allopurinol. Probenacid is a weak organic acid so it affects the renal levels of other organic acids (ASA, PCN, etc.)
Think: >800, ProbenAcid instead.