Gout, CPPD & osteoarthritis flashcards
15 high-yield MRCP Part 1 cards from the Intellect Medicos Rheumatology course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.
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What is the gold-standard investigation for gout, and what does it show?
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Joint aspiration with polarised microscopy: needle-shaped, negatively birefringent monosodium urate crystals.
Why? Serum urate can be normal during a flare, so crystals are the definitive test. Ultrasound may show a "double contour" sign.
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What are the NICE first-line drug options for an acute gout flare?
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An NSAID (with a PPI), colchicine, or a short course of oral corticosteroid — chosen by comorbidities and preference.
Why? If these are unsuitable or ineffective, an intra-articular or IM corticosteroid injection can be used.
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What is the mechanism of action of colchicine?
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It inhibits microtubule polymerisation, reducing neutrophil migration and activation.
Why? Diarrhoea, abdominal pain and vomiting are dose-limiting; bone marrow suppression occurs in toxicity.
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Name three indications for offering urate-lowering therapy in gout (NICE).
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Any three: multiple or troublesome flares, CKD stages 3–5, diuretic therapy, tophi, chronic gouty arthritis.
Why? NICE also advises discussing ULT with everyone after their first flare.
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When should urate-lowering therapy be started in relation to a gout flare?
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At least 2–4 weeks after the flare has settled.
Why? Changing urate levels mobilises crystals and can prolong a flare.
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According to NICE (2022), what is the first-line urate-lowering drug for gout?
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Allopurinol or febuxostat (allopurinol specifically if the patient has major cardiovascular disease).
Why? Both are xanthine oxidase inhibitors; treat to target, starting at a low dose (e.g. allopurinol 100 mg daily) and titrating monthly.
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What serum urate target is used in treat-to-target gout management?
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Below 360 micromol/L — or below 300 micromol/L if there are tophi, chronic gouty arthritis or ongoing flares.
Why? Keeping urate below its saturation point dissolves existing crystals over time.
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Which drug is offered to prevent flares when starting or titrating urate-lowering therapy?
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Low-dose colchicine (low-dose NSAID or steroid if colchicine is unsuitable).
Why? Falling urate can trigger flares early in treatment; prophylaxis continues while the target urate is reached (the slides say about 6 months).
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Which HLA allele increases the risk of severe allopurinol hypersensitivity (SJS/TEN), especially in Han Chinese, Thai and Korean people?
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HLA-B*58:01.
Why? Allopurinol hypersensitivity syndrome presents with rash progressing to SJS/TEN; risk is also higher in CKD.
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Which antihypertensive has a mild uricosuric effect and is useful in patients with gout?
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Losartan.
Why? Thiazide and loop diuretics raise urate, so switching to losartan can help where clinically appropriate.
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Pseudogout is caused by calcium pyrophosphate crystals, which are ______; the classic X-ray sign is chondrocalcinosis.
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rhomboid-shaped and weakly positively birefringent
Why? It usually affects the knee of an older person; first-line treatment is an NSAID, with colchicine or steroids as alternatives.
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Pseudogout is caused by calcium pyrophosphate crystals, which are rhomboid-shaped and weakly positively birefringent; the classic X-ray sign is ______.
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chondrocalcinosis
Why? It usually affects the knee of an older person; first-line treatment is an NSAID, with colchicine or steroids as alternatives.
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A 45-year-old man has an acute hot knee. Aspiration shows rhomboid, weakly positively birefringent crystals. Name two metabolic conditions that should be screened for.
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Any two: haemochromatosis, hyperparathyroidism, hypomagnesaemia (also hypothyroidism, hypophosphatasia).
Why? CPPD disease in a patient under about 60 suggests an underlying metabolic cause.
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The four X-ray signs of osteoarthritis are Loss of joint space, ______, Subchondral ______ and Subchondral ______.
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Osteophytes; sclerosis; cysts
Why? These reflect cartilage loss and bone-on-bone remodelling. In erosive hand OA, central erosions give a "gull-wing" appearance.
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What is the first-line drug treatment for knee osteoarthritis (NICE)?
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A topical NSAID.
Why? Alongside exercise and weight loss. Next step: an oral NSAID with a PPI; intra-articular steroid gives short-term relief (2–10 weeks).