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CC July 2017 Diagnosis of gout

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echoecho's version from 2018-04-25 15:16

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Question Answer
Define gout?It is an inflammatory arthritis that is characterized by precipitation of monosodium urate crystals in a joint space
Gout is the most common inflammatory arthropathy, affecting about ___ million individuals in the US?8
Gout is caused by what 2 causes, which one is more common?1) overproduction of uric acid 2) underexcretion of uric acid (more common)
List the risk factors?1) increased age 2) male gender 3) excessive consumption of alcohol, red meat, purine-rich diet 4) use of diuretics
Beer and "hard" liquor such as whisky are associated with gouty attacks more so than ______ (which has not been found to be a risk factor in modest amounts)?Wine
The original American College of Rheumatology (ACR) diagnostic criteria for acute gout were published in 1977. When compared to the gold standard of monosodium urate crystals in synovial fluid or tophus, the 1977 guidelines had a sensitivity of 57% to 100% and a specificity of 34% to 86%. In order to improve the diagnostic accuracy of classification criteria in 2015, the ACR and European League Against Rheumatism (EULAR) issued updated, joint criteria in a 3-step process, list these?STEP 1 = must have a least one episode of swelling, pain or tenderness in a peripheral joint or bursa. STEP 2 = if urate crystals are seen in fluid from a symptomatic joint or bursa or from a tophus, the diagnosis is met and no further steps are needed STEP 3 = if the first step is met but the second is not, a scoring system may be used
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STEP 3 SCORING FOR DIAGNOSIS OF GOUT:
Question Answer
For STEP 3 scoring for the diagnosis of gout, list the categories?1) clinical 2) characteristics of episode 3) time course of episode 4) clinical evidence of tophus 5) serum urate lab results 6) fluid/tophus analysis 7) imaging
What are the clinical findings to get 1 point? To get 2 points?1 POINT = ankle or mid foot (as part of monoarticular or oligoarticular episode w/o involvement of the fist metatarsophalangeal joint. 2 POINTS = involvement of the first metatarsophalangeal joint (as part of monoarticular or oligoarticular episode)
Regarding the charactistics of episode, list the possible 3 characteristics of an episode? To get 1 point? To get 2 points? To get 3 points?1) erythema overlying joint; patient cannot bear touch or pressure to affected joint; great difficulty with walking or inability to use affected joint 2) 1 POINT = 1 characteristic 3) 2 POINTS = 2 characteristics 4) 3 POINTS = 3 characteristics
Regarding the time course of episode, define a typical episode? To get 1 point? To get 2 points?1) a typical episode must have 2 or more of the following = time to maximal pain < 24 hours; resolution of symptoms < 14 days; complete resolution between episodes. 2) 1 POINT = 1 typical episode 3) 2 POINTS = recurrent typical episode
Regarding clinical evidence of tophus, where are tophus found? To get 4 points?1) joints, ears, olecranon, bursae, finger pads, Achilles' tendon 2) 4 POINTS = draining or chalk-subcutaneous nodule under transparent skin, often w/ overlying vascularity
Regarding urate lab results (no active urate-lowering treatment and > 4 weeks after the start of an episode). To get - 4 points? To get 2 points? To get 3 points? To get 4 points?1) - 4 POINTS = < 4 mg/dL. 2) 2 POINTS = 6-7.9 mg/dL 3) 3 POINTS = 8-9.9 mg/dL. 4) 4 POINTS = > 10 mg/dL
Regarding the fluid/tophus analysis, to get - 2 points?- 2 POINTS = no urate crystals are seen in fluid from a symptomatic joint or bursa or from a tophus
Regarding imaging, list the types? To ways to get 4 points?1) imaging evidence of urate deposition in symptomatic joint or bursa (US evidence of double-contour sign or dual energy computed tomography (DECT) demonstrating urate deposition. Imaging evidence of gout-related joint damage (conventional radiographs of the hands and/or feet show at least one erosion) 2) US or DECT criteria OR erosions present
*** According to the guidelines, the maximum possible score of Step 3 criteria is ____; a threshold score of ____ points or more is considered diagnostic of gout?23; 8
When applied to a test population, the sensitivity was ___% and the specificity was ___% compared to the gold standard?92%; 89%
*** The ACR and EULAR both recommend the use of these criteria over the original 1977 criteria, true or false?true
The gold standard for diagnosis remains what?identification of urate crystals in the involved joint Orin tophaceous deposits
Unfortunately, aspiration can be difficult in ____ joints?small
The use of guidelines such as the the one above is recommended because of difficulty in aspirating small joints and because several conditions can mimic acute gouty arthritis, list these?1) acute septic arthritis 2) crystalline-associated arthritis (calcium pyrophosphate deposition (CPPD) 3) psoriatic arthritis
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SUMMARY:
Question Answer
*** SUMMARY = How does acute gout present?1) severe joint pain and swelling 2) joint is red, warm and exquisitely tender
*** SUMMARY = The dx is best established by identification of urate crystals in joint aspirate, but clinical criteria may be used when aspiration is ____ to perform?difficult
*** SUMMARY = Chronic gout may affect several joints and can be confused with what 2 conditions?1) OA 2) RA
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