Gout Flashcards
What is gout/
Deposition of monosodium urate deposits in the tissue
Where can monosodium urate depost?
Synovial fluids
Tissues
Kidney
What is the building block of monosodium urate?
Uric acid
What is uric acid?
End of purine metabolism (Over excess consumed in the population)
What is the function of Uric acid?
Nothing
What is overproduction or under excretion of uric acid called?
Hyperuricemia
What are the Oxidase inhibitors
Xo inhibitors (Allopurinol, Oxipurinol, Febuxosat.
What are the Uric Oxidase used for?
Takes uric acid to allantoin
What are the two Uric Oxidase inhibitors?
Rasburicase
Peg-uricase
What is Hyperurecemia?
Serum uric acid concentration over 420umol/min
What is generally the solubility of uric acid in the synovial space?
420 hence anything higher can cause it to supersaturate
What can trigger uric acid to precipitate?
Low temperatures and trauma
How does overproduction of uric acid occur>?
Overconsumption of rich in purine food,
Obesity
Hypertriglyceridemia
Diuretics
Cytotix drugs
How can diuretics lead to hyperuricemia?
Dont cause a direct increase in levels, they do lead to fluid leaving the synovial space leading to an increased concentration at the site
Can also lead to decreased excretion though a little bit
What disease states can lead to hyperuricemia?
CKD
Hypertension
Dehydration
What drugs can cause increased uric acid levels?
Alcohol
Ace/ARb
ASA
Cyclosporine
Diuretics
Levodopa
Tacrolimus
Take some time to review this figure
This is how uric acid can be secreted in the kidney
What clinical situation may we check uric acid levels?
Just for 1 drug that only looks at low levels
Excretion of ___/24 hours means an overproducer
1000mg
What is the prevelance of Gout>?
3% of world
What is the presentation of gout? (4)
Asymptomatic hyperuricemia
Acute gout arthritis
Intercriticial gout
Chronic tophaceous gout
What is Asymptomatic hyperuricemia?
Greater then 420 level and the majority do not require drug treatment
Generally an incidental finding though
Potential consequence of Asymptomatic hyperuricemia?
Gout
Urate nephropathy
Nephrolitiasis
CKD
What is acute gouty arthritis?
Can happen in any join 90% of single joint occurs for first attack
What are the possible triggers of gout attack?
In general anything that causes a rapid change in ___ leads to gout
Uric acid concentrations
What is the intercritical gout stage?
Asymptomatic period between flares than can last 2-10 years
Does shorten as disease progresses
Best to discuss patient education and some patients may receive prophylaxis
What is CHronic tophaceous gout?
Tophi are uric acid depoists, late complicaiton of hyperuricemia
What are to complications of Gout complications?
Nephrolithiasis
Urate nephropathy
Review the next chart
What are the lab tests that are generally used for gout?
CBC
Urinalysis
BUN serum uric acid levels
Diagnosis is mainly based off of the symptoms
