Gout Flashcards
Gout (gouty arthritis)
an INFLAMMATORY disease resulting from deposits of uric acid crystals in tissues and fluids within the body
Gout: Pathogenesis
KEY CONCEPT: URIC ACID CRYSTAL deposits in tissues
Normally, uric acid dissolves in the blood and excreted by the kidneys
Etiology: HYPERURICEMIA
-overproduction of uric acid
-under excretion of uric acid
What causes uric acid crystals to form?
from the breakdown of PURINES
-body makes purines
-found in food: organ meats, shellfish, anchovies, herring, asparagus, mushrooms, soft drinks
Gout: Risk Factors (7)
-obesity
-pre-existing diseases: HTN, DM, renal disease, sickle cell anemia
-consuming ETOH (beer and spirits)
-diet rich in meat and seafood
-use of diuretics
-most common in males
-African Americans
Gout: Phase 1
ASYMPTOMATIC but with elevated serum uric acid levels and deposits in tissues
crystals accumulate and tissue IS DAMAGED
tissue damage triggers ACUTE INFLAMMATION
Gout: Phase 2
ACUTE FLARES or attacks occur- HYPERURICEMIA
Gout: Phase 3
CLINICALLY INACTIVE until the next flare- continued hyperuricemia
may be months or years before the next flare. Later, reoccurring attacks get closer and closer together
Gout: Phase 4
CHRONIC ARTHRITIS- joint pain and other sx present most of the time
Gout: CM (6)
-pain
-may be mild or
excruciating
-usually the lower
extremities
-burning
-redness
-swelling and warmth
-fever
-symptoms present for days to weeks
What is the presenting joint for 50% of people with gout?
metatarsophalangeal joint of the big toe
Gout: Complications (2)
Tophi: large HARD NODULES composed of uric acid crystals deposited in soft tissues
-may form below the skin around the joints
-can cause a local inflammatory response
-may drain CHALKY MATERIAL
Renal Calculi: kidney stones (of uric acid)
Gout: Goal of Pharm
decrease symptoms of an acute attack AND prevent recurrent attacks
NSAIDs are usually 1st line therapy
Other drug therapy discussed: allopurinol (Zyloprim), colchicine, probenecid
