gout Flashcards
gout (gout is pure crystal)
Gout : is a disorder of purine metabolism that is characterized by the deposition of sodium urate crystals in articular, periarticular (tissues around the joint) and subq tissue.
GOUT: CLASSIFICATION - primary (Men vs. women, age, and history?)
Primary:
Most common gout
Middle aged men – 90%
25% have (+) family history
In women onset is post-menopausal
GOUT: CLASSIFICATION - secondary (and age groups?) (gout knows no boundaries)
Related to other disorders or meds
Affects people of all ages
PRIMARY GOUT: ETIOLOGY
Problem with purine metabolism
End product of purine metabolism is uric acid
Uric Acid accumulates in the blood and deposits in synovium and other tissues.
↑ serum uric acid levels = Hyperuricemia
HYPERURICEMIA - what causes it? (too much, can’t get it out, food)
is a biochemical abnormality that could be due:
Impaired renal excretion of uric acid
Over production /biosynthesis of uric acid
“over- consumption of food rich in purine”?
All patients with gout have hyperuricemia.
ACUTE GOUT: CLINICAL MANIFESTATION - when does it peak?
Acute onset of swelling and pain in affected joints.
Peaks in several hours
CHRONIC GOUT - tophi in what % of pts?
Tophi in 30% of pt’s
GOUT: DIAGNOSTICS - are uric acid levels usually high?
Single uric acid levels are normal in 25% -50% of acute gout attacks.
GOUT: MEDICAL MANAGEMENT - no what?
Anti-Inflammatory meds:
NSAIDS (Indocin, Motrin) Tx of choice. Anti-inflammatory medication & Analgesic
NO Aspirin-inhibits uric acid secretion
HOW TO PREVENT FUTURE GOUTY ATTACKS - what foods?
Avoid foods that are high purine that can precipitate a gout attack:
.
ETOH (beer, alcohol)
All meats and seafood
\
Probenicid - MOA
Can increase uric acid excretion
Allopurinol (Zyloprim) (Block ALL uric acid)
blocks the production of uric acid
can control serum levels to prevent renal stones.
Febuxostat - (Ted is Flumoxed)
New drug
xanthine oxidase inhibitor approved by the FDA in 2009
Reduces serum uric acid levels
second-line therapy
New research (Phase 3Trials)
secondary gout - causes (Ted - door)
DM
ETOH
HTN
Cancer
Sickle cell
chemotherapeutic agents
The higher the uric acid level, the earlier the appearance of
tophi
acute gout - how long does it last?
lasts 2 – 10 days with or without tx
acute gout - main place there is inflammation?
75% experience acute inflammation and pain of the great toe (podagra: first metarsophalangeal joint).
acute gout - what body parts? (gout is WAKE)
Can occur in ankle, knee, wrist, elbow
acute gout - what plays a central role in acute attacks? (neutrophils are not Ted’s friend)
The phagocytosis of MSU crystal by neutrophil play a central role in acute attacks.
chronic gout - where do you get it? (Chronic ted is all over)
Occur on tendons, bursa, skin, bone, cartilage and pharenchymal tissue as well.
chronic gout - tophus
Tophi can become large and perforating.
Tophus: are deposit of MSU crystal surrounded by granulomatus inflammation.
gout - serial uric acid levels (serial tells it all)
95% of serial uric acid levels during the course of an acute attack will be ↑ (>7.5)
how to make a Definitive diagnosis
can be made by joint aspiration of urate crystals
gout meds - COLCHICINE (chemo colchicine) and side effects?
COLCHICINE
Inhibits chemotaxis thus interfering with the inflammatory response to urate crystals.
80% can have GI upset (N/V/D, cramps)
gout - steroids
Corticosteroids only if other meds ineffective
how well do meds work?
Medications control symptoms 75% of the time
avoid what foods? (Ted can’t have oatmeal or mushrooms)
Oatmeal
Mushrooms
Sardines
Herring
probenicid - must have what? (creatinine is a pro)
Must have normal creatinine clearance
Avoid ASA as it counteracts effect
probenicid - must do what? (Ted is a pro at urine)
Maintain urine output > 2 L/day to minimize uric acid precipitation in the urinary tract (Kidney stones)
allopurinol - check what levels? and what number? (Al is less than 6)
Check serum uric acid levels: Goal: < 6 mg/dl.
Benlysta (Ben an antibody)
Benlysta (antibody to fight dz, currently approved for SLE)
Stem cell transplants
DHEA hormone….
gout attack - what foods (acidic foods)
Beans, peas, spinach, asparagus, cauliflower
