CC July 2017 Dx of gout

echoecho's version from 2017-09-05 17:24


Question Answer
Define gout?An inflammatory arthritis that is characterized by precipitation of monosodium urate crystals in a joint space
It is the most common inflammatory arthropathy, affecting how many individuals in the USA?8 million
What is the cause of hyperuricemia?1) overproduction of uric acid 2) underexcretion of uric acid is more common
List the risk factors for gout?1) increased age 2) male gender 3) excessive consumption of alcohol 4) red meat 5) purine rich diet 6) use of diuretics
True or false? Beer and "hard" liquor such as whisky are associated with gouty attacks more so than wine (which has not been found to be a risk fox in modest amounts)?true
***The original American College Rheumatology (ACR) diagnostic criteria for acute gout was published in 1977 and the sensitivity was 57-100% and specificity was 34-86%. So in order to improve the diagnostic accuracy, in 2015 the ACR and EULAR issued an updated criteria in a 3-step process. List these?1) step 1 = must have a least one episode of swelling, pain or tenderness in a peripheral joint or bursa 2) step 2 = if urate crystals are seen in fluid from a symptomatic joint or bursa or from a tophus, the Dx is met an no further steps are needed 3) if the first step is met but the second is not, a scoring system may be used
List the classifications in the new scoring for diagnosis of gout1) clinical 2) characteristic of episode 3) time course of episode 4) clinical evidence of tophus 5) serum urate lab results 6) fluid / tophus analysis 7) imaging
What is the scoring point for ankle or mid foot (as part of the monoarticular or oligoarticular episode w/o involvement of the first metatarsopharalangeal joint)?1 point
What is the scoring point for involvement of the fist metatarsophalangeal joint (as part of monoarticular or oligoarticular episode)?2 points
What is the scoring points for the following characteristics of episode = erythema overlying joint; put cannot bear touch or pressure on affected joint; great difficulty with walking or inability to use affected joint?1) one characteristic = 1 point; 2) two characteristics = 2 points; 3) three characteristics = 3 points
What is the scoring points for the time course of the episode = typical episode is 2 or more of the following (time to maximal pain < 24 hours; resolution of symptoms < 14 days; complete resolution between episodes)?1)one typical episode = 1 point; 2) recurrent typical episode = 2 points
What is the scoring points for clinical evidence of tophus (found in typical areas of joints, ears, olecranon bursae, finger pads, Achilles' tendon)?draining or chalk-like subcutaneous nodule under transparent skin, often with overlying vascularity = 4 points
What is the scoring points for serum urate lab results where no active urate lowering treatment and > 4 weeks after the start of the episode?1) < 4 mg/dL = minus 4 points; 2) 6-7.9 mg/dL = 2 points; 3) 8-9.9 mg/dL = 3 points; 4) > 10 mg/dL = 4 points
What is the scoring points for fluid/tophus analysis where no urate crystals are seen in fluid from a symptomatic joint or bursa or from a tophus?minus 2 points
What is the scoring points for imaging (US or DECT criteria) that shows evidence of urate deposition in symptomatic joint or bursa (US evidence of double-contour sign or dual-energy CT (DECT) demonstrating urate deposition?4 points
What is the scoring points for imaging (erosions present) that shows gout joint damage (conventional radiographs of the hands and/or feet show at least one erosion)?4 points
*** According to the guideline, the maximum possible score of the Step 3 criteria is _____; a threshold score of ____ points or more is considered diagnostic of gout?23; 8
*** Which two entities recommend using the new 2015 classification criteria for diagnosing gout?1) ACR (American College of Rheumatology) 2) EULAR (European league AGainst Rheumatism)
What is the new sensitivity and specificity of the new 2015 classification criteria compared to the gold standards criteria?sensitivity 92%; specificity 89%
The gold standard for diagnosis remains the identification of what?urate crystals in the involved joint or in tophaceous deposits
True or false. Aspiration can be difficult in small joints?true
Why is the use of the new guidelines recommended?1) aspiration can be difficulty in small joints 2) several conditions can mimic acute gouty arthritis
List several conditions that can mimic acute gouty arthritis?1) acute septic arthritis 2) crystalline-associated arthritis such as calcium pyrophosphate deposition (CPPD) disease 3) psoriatic arthritis
***SUMMARY = What are the s/s of acute gout?1) severe joint pain and swelling 2) joint is red, warm and exquisitely tender
***SUMMARY = True or false? The diagnosis is best established by identification of urate crystals in joint aspirate, but clinical criteria may be used when aspiration is difficult to perform?true
*** SUMMARY = Chronic gout may affect several joints and can be confused with what two types of arthritis?1) OA 2) RA