Gout Flashcards
What is gout?
a common type of inflammatory arthritis that causes severe pain, discomfort, and damage to joints
What are the causes of gout?
deposition of monosodium urate crystals in areas of slow blood flow like joints and renal tubules. Crystals formed from excess uric acid and uric acid formed from breakdown of purine nucleotides from ingested sources.
An inflammatory reaction only occurs when?
the crystals are shed into the bursa (small sacs of synovial fluid that surround the joint)
What triggers the shedding of crystals?
Direct trauma, dehydration, rapid weight loss, illness and surgery
What are some risk factors for developing Gout?
increased purine intake, overproduction of uric acid, taking loop and thiazide diuretics, some medicines, genetic predisposition, obesity, hypertension, dyslipidaemia, alcohol, male gender
What are some medicines that can increase uric acid levels?
aspirin, ciclosporin, cytotoxic meds, diuretics, ethambutol, levodopa, pyrazinamide, ribavirin, and interferon, teriparatide
What is the method of diagnosis?
polarised light microscopy, fluid drawn form joint and examined, uric acid levels measured during acute attack to aid diagnosis
Where does the first attack of acute gout affect?
single joint in lower limbs (commonly big toe) but further attacks may involve multiple joints
What are some symptoms of acute gout?
pain most severe between 6 to 24 hours of onset, affected areas red and swollen with shiny overlying skin, fever, leukocytosis and raised inflammatory markers
Treatment for gout
NSAIDs are first line, an alternative to an NSAID is Colchicine and if colchicine and NSAIDs are C/I or ineffective then give corticosteroids
Why are loop and thiazide diuretics associated with the development of gout?
Because diuretics increase urination, which reduces the amount of fluid in your body, but the remaining fluid is more concentrated, which can increase the risk that you’ll develop the crystals that cause gout. Some types of diuretics also reduce the kidneys’ excretion of urate, a component of uric acid
Who is given prophylactic treatment of gout?
patients with visible gouty tophi, those with renal insufficiency, those with uric acid stones, those who need to continue diuretics
Describe prophylactic treatment of gout
commenced 2-3 weeks after gout attack resolved, an NSAID or colchicine is co-prescribed. Allopurinol also a medicine of choice for prophylaxis in the management of recurrent gout. It inhibits the action of the enzyme xanthine oxidase, thus reducing the production of uric acid. Febuxostat recommended for patients with chronic hyperuricaemia who are intolerant of allopurinol or for whom allopurinol is contraindicated. Febuxostat is a more selective and potent inhibitor of xanthine oxidase than allopurinol and has no effect on other enzymes involved in purine or pyrimidine metabolism. Uricosuric meds such as sulphinpyrazone can also be given as they increase excretion of uric acid
What is the aim of normal treatment and prophylactic treatment?
to relieve pain rapidly but prophylactic treatment to maintain serum uric acid levels below the saturation point of monosodium urate (where crystal deposits dissolve)
What counselling should be given for colchicine?
common side effects include abdominal cramps, vomiting and nausea, can interact with some meds to be aware. Take 2-4 500mcg tabs daily
