Gout, Pseudogout

Clinical Features
Coffee is protective against gout, but intense exercise and microtrauma can precipitate
For rheumatoid rather than reactive, symptoms must be >8 weeks.
Ask about skin (ank spond linked to psoriasis), butterfly rash in the heat (SLE), morning stiffness (RA has atleast an hour), diarrhoea, blood, eye signs, miscarriages
If it's 1st MTP - gout most likely
There can be RA accelerated atherosclerosis

Examination
Red, hot, shiny joint is likely to be gout
95% of nodules are gout or RA.

Investigations
10-40% have a normal urate during flares

Treatment
NSAIDs - topical or oral
Colchicine
Rheumatoid - conside steroids 10mg for 3days
Stop DMARDs if infection - for up to two weeks - they have long term not short term effect
**NO METHOTREXATE AND TRIMETHOPRIM**

Diagnosis
May be a manifestation of systemic illness:
Sarcoidosis
Vasculitis
Systemic lupus erythematosus (SLE)
Behcet’s disease
Reiter’s syndrome /Reactive arthritis
Hypertrophic pulmonary osteoarthropathy (HPOA)
Ankylosing spondylitis (tends to affect axial skeleton)
Familial mediterranean fever
Amyloid arthropathy
Rheumatic fever


https://emergencymedicineireland.com/2015/05/tasty-morsels-of-em-049-gout/
rheumatology.oxfordjournals.org/content/45/8/1039.full.pdf
https://www.rcemlearning.co.uk/modules/the-angry-ankles-how-to-manage-acute-polyarthritis-in-the-ed/
https://www.rcemlearning.co.uk/foamed/transient-synovitis/
https://www.rcemlearning.co.uk/modules/a-shocking-knee/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2585712/
https://www.genome.gov/Genetic-Disorders/Familial-Mediterranean-Fever