CRYSTAL INDUCED ARTHR

Question 1

a disease of both metabolism and inflammation/immunity

Answer 1

gout

Question 2

pathogenesis of gout?

Answer 2

uric acid in form of crate means precipitation of urate into crystal form

Question 3

characteristics of gout?

Answer 3

hyperuricemia
acute arthritis with urate crystals 
tophi deposited around joints
renal disease
uric acid nephrolithiasis

Question 4

breakdown product of uric acid is what type of metabolism?

Answer 4

purine

Question 5

generation of uric acid is dependent on _____?

depletion of uric acid is dependent on _____?

Answer 5

intrinsic pruine production and purine intake

excretion

*purines in both DNA and RNA (adenine and guanine)

Question 6

elevated uric acid levels can deposit crystals occult or in the form of noticeable masses around or in the joint called?

Answer 6

tophi

Question 7

factors that influence precipitation of crystals include?

Answer 7

lower pH
lower temp
joint space and cartilage role
immune response

Question 8

inborn errors of metabolism equals primary or secondary hyperuricemia production?

Answer 8

primary

Question 9

conditions that induce cell turnover that produces purines and purine breakdown equals primary or secondary hyperuricemia production?

i.e. erythropoietic disease like anemias, sickle cell disease, myloproliferative disorders like multiple myeloma

Answer 9

secondary

Question 10

most common cause of hyperuricemia?

Answer 10

underexcretion

Question 11

hereditary defects in renal tubule rate excretion is primary or secondary excretion

Answer 11

primary underexcretion

Question 12

acute and chronic renal failure, drugs and toxins, systemic illness that alters rate handling directly or indirectly

Answer 12

secondary underexcretion

Question 13

drugs that affect under excretion?

Answer 13

thiazide diuretics
loop diuretics
ETOH
ASA

Question 14

most common site of hyperuricemia?

Answer 14

1 MPJ

Question 15

risk factors for gout?

Answer 15

ASA, thiazide, loop diuretic
genetics 
obesity 
metabolic syndrome
CAD
hypothyroidism
Diet

Question 16

foods that increase likely hood acute gout attack?

decrease?

Answer 16

seafood
red meat
fructose
ETOH
leafy green vegetables

low fat diary products
milk
vitamin C

Question 17

stages of gout?

Answer 17

asymptomatic hyperuricemia
acute gouty arthritis
inter critical gout
chronic gout

Question 18

• Urate level in serum high but no acute attack of gout either in the joint or nephrolithiasis
• This stage ends with the first gout attack

Answer 18

Asymptomatic Hyperuricemia

Question 19

Acute Gout- Clinically manifests as?

Answer 19

acute/rapid onset
intensely painful
usually monoarticular
affected area is hot
fever, chills, malaise
sloughing skin

Question 20

common sites affected by acute gout?

Answer 20

over in shorter time intervals

1 MPJ most common site then midfoot, ankles, heels, wrists, finger and elbows

Question 21

name this stage of gout?

◦ Period between Acute Gout attacks
◦ Usually suffer another attack within 6 months to 2 years after the 1st attack
◦ Radiographic changes may occur during the intercritical period

Answer 21

Intercritical Gout

Question 22

name this stage of gout?

◦ Polyarticular gout with no pain free intercritical periods
◦ Visible Tophi
◦ Needs to be differentiated between other arthropathies
◦ Rate of Tophi formation correlates with degree and
duration of hyperuricemia
◦ Severity of renal disease and use of diuretics can influence chronic gout

Answer 22

chronic gout