Gout

Question 1

consequences of hyperuricemia

Answer 1

asymptomatic, gout, urolithiasis, urate nephropathy

Question 2

Patient presents with high levels of uric acid. What med do you check in history?

Answer 2

thiazide use for HTN- reduces uric acid excretion

Question 3

what is HALLMARK of gout

Answer 3

intercritical period gout- period between flares

Question 4

stages of gout

Answer 4

acute gouty arthritis, intercritical period, chronic recurrent and tophaceous gout

Question 5

most common location affected in gout..and second most common?

Answer 5

first metatorsophalangeal joint of great toe, then knee

Question 6

single joint or multiple joints in gout affected?

Answer 6

80% of initial attacks involve SINGLE joint

Question 7

acute gouty arthritis- patient will present most often with severe pain, redness, swelling, and disability of one single joint in body- usually PAINFUL, BIG TOE. what do you tell them about resolution of symptoms?

Answer 7

will take few days to several weeks, complete resoluation with or without meds!

Question 8

labs in acute gouty arthritis

Answer 8

neutrophilic leukocytosis, elevated sed rate, elevated CRP, serum uric acid level may be normal or elevated

Question 9

In cases of untreated gout, acute polyarticular gout may occur commonly- it is more commonly a/w special populations including

Answer 9

people with myeloproliferative or lymphoproliferative disorders, or patients with history of organ transplant who are receiving cyclosporine

Question 10

“needle-shaped” birefringement, yellow describes

Answer 10

urate crystals

Question 11

best way to diagnose gout

Answer 11

joint aspiration- visualize crystals- 100% specific, 85% sensitive

Question 12

xray finding in gout

Answer 12

rat bite- punched out juxta-articular lesion, subcortical bone cyst

Question 13

clinical diagnosis with total 13 points

Answer 13

serum uric acid level about 5.88 mg/dl, male, previous arthritis attack, big red toe involved, HTN or at least one CV disease, joint redness, onset within one day

Question 14

How often after first attack is second attack usually? (how long is intercritical period)

Answer 14

2 years

Question 15

what happens to intercritical period if disease is left untreated?

Answer 15

becomes shorter and flares become more severe

Question 16

describe characteristic finding in chronic tophaceous gout stage

Answer 16

presence of tophi that can be palpated (collections of solid urate in CT)

Question 17

are tophi painful or tender?

Answer 17

no- that’s why often not removed

Question 18

patient with gout has elevated serum creat, bland urine sediment, and hyperuricemia that is crazy high. what do you suspect is going on?

Answer 18

chronic urate nephropathy- urate crystals depositing in renal medullary interstitium

Question 19

1st line pharmocologic therapy for acute gouty arthritis

Answer 19

NSAIDS/COX 2 inhibitors- Naproxen or indomethacin.

Question 20

2nd line pharmocologic thearpy for acute gouty arthritis

Answer 20

colchinine

Question 21

hospitalized patients with acute gouty arthritis tx

Answer 21

often NSAIDS are risk factors for these patients. Intraarticular or IV glucocorticoids, IM or SQ ACTH, IV colchinine

Question 22

long term management of gout includes

Answer 22

talking to patient about lifestyle modifications (alcohol, obesity), comorbid disease management, urate lowering therapy, NSAID or colchinine therapy (more for acute attacks)

Question 23

2 types of therapies that are “urate lowering”-

Answer 23

uricosuric drugs- increase uric acid exretion and xanthine oxidase inhibitors- decrease production of uric acid

Question 24

examples of uricosuric drugs used in tx of gout

Answer 24

probenacid

Question 25

probenacid should be avoided in..

Answer 25

patients that are at risk for nephorlithiasis or nephropathy

Question 26

when is urate lowering therapy indicated?

Answer 26

more than 2-3 attacks/year, signs of CHRONIC gout, tophaceous deposits present, renal insufficiency or nephrolithasis in patient with gout, and if uric acid excretion levels are more than 1100 mg/day in men less than 25 or postmenopausal women

Question 27

GOAL OF urate lowering therapy

Answer 27

serum urate concentration less than 6 mg/dl. if tophi present, less than 5

Question 28

xanthine oxidase inhibitors

Answer 28

allopurinol, febuxostat

Question 29

what med is preferred for gout patients over 60 who have tophi?

Answer 29

allopurinol

Question 30

difference between gout and pseudogout

Answer 30

gout- monosodium urate crystals. pseudogout- calcium pyrophosphate

Question 31

population affected in pseudogout

Answer 31

WOMEN over 65

Question 32

chondrocalcinosis

Answer 32

radiographic calcification in hylaine and/or fibrocartilage

Question 33

pseudogout preferred term

Answer 33

acute CPP (calcium pyrophosphate) crystal arthritis

Question 34

pesudogoup most common location

Answer 34

knee

Question 35

pseuodogout can mimic many diseases

Answer 35

pseudo-RA, pseudo-OA, pseudo-neuropathic joint disease

Question 36

systemic symptoms more common in gout or pseudogout?

Answer 36

gout

Question 37

Xray of pseudogout

Answer 37

chondrocalcinosis, degernative changes

Question 38

"rhomboid shaped pale blue" deposits

Answer 38

CPPD crystals

Question 39

Tx of acute pseudogout

Answer 39

joint aspiration removal or crystals, nsaids or colchinine, glucocorticoid injection, joint immobilization, ice or heat

Question 40

tx of pseudo-RA first choice

Answer 40

NSAIDS, colchinine

Question 41

PREVENTION for acute pseudogout

Answer 41

colchinine (if patient with 3 or more attacks annulally)