gout

Question 1

what is gout

Answer 1

the build up of uric acid crystals in the joints

Question 2

what are the stages of gout

Answer 2

• asymptomatic
• acute gout - pain, swelling, redness and spontaneous resolutions over 7 to 10 days
• chronic gout
• intermittent gout
• tophaceous gout - this is characterised by polyarticular attacks, progressive joint destruction, urate crystals in soft tissue and joints (tophi)

Question 3

what illness can make people get gout

Answer 3

• LESCH NYHAM syndrome- over production of uric acid
• RENAL FAILURE - under excretion of the uric acid
• LEAD TOXICITY
• DRUGS
• IDIOPATHIC FACTORS

Question 4

what are some predispositional factors to give someone gout

Answer 4

• gender (men)
• family history
• body size
• diet (purine rich foods)
• alcohol consumption
• diuretic use
• reno impairment

Question 5

Inflammation in Gout:

Answer 5

Develops from hyperuricemia with uric acid crystals
Uric acid crystals stimulate:
Inflammatory signals
Activation of complement
Chemoattraction of neutrophils
Cytokines involved: IL-1, IL-6, TNF-α
Inflammasome, especially IL-1, implicated in gout onset

Question 6

investigations for gout

Answer 6

Joint aspiration and polarized light microscopy for crystal detection
FBC: Raised WBC
ESR: Raised
X-ray: Normal in acute gout
Serum uric acid levels elevated (>10mg/L), but high levels don’t necessarily mean gout

Question 7

Gout and Underlying Health Conditions:

Answer 7

Linked to conditions like hypertriglyceridemia, low HDL cholesterol, insulin resistance, obesity, hypertension
Gout-like symptoms can serve as a screening tool for underlying health problems

Question 8

Treatment of Acute Gout Attacks:

Answer 8

Aims to reduce symptoms
Commonly used: NSAIDs, colchicine, prednisolone
NSAIDs at high doses (except aspirin)

Question 9

Colchicine

Answer 9

Alkaloid preventing and relieving acute gout attacks
Blocks neutrophil migration, inflammatory glycoprotein production
Side effects: Gastrointestinal symptoms, toxicity at high doses

Question 10

long term control of gout

Answer 10

Involves lifestyle changes and drug therapy
Common drugs: Xanthine oxidase inhibitors (allopurinol, febuxostat), uricosuric agents
Drug therapy not started during an attack but after settling

Question 11

Allopurinol:

Answer 11

Allopurinol:
Drug of choice for long-term gout treatment
Reduces uric acid synthesis by inhibiting xanthine oxidase
Side effects: Mainly gastrointestinal, rare Stevens-Johnson syndrome
Not effective for acute attacks

Question 12

Febuxostat:

Answer 12

Febuxostat:
Another xanthine oxidase inhibitor reducing uric acid levels
Side effects: Gastrointestinal symptoms, joint stiffness, headaches
Contraindicated with some chemotherapeutic drugs, costly

Question 13

Other Gout Treatment Options:

Answer 13

Other Gout Treatment Options:
Uricosuric agents (sulfinpyrazone, benzbromarone)
Block uric acid reabsorption, increase excretion in urine
Biologics (canakinumab)
Target IL-1β pathways and P2X7 receptors