Gout

Question 1

What is gout/

Answer 1

Deposition of monosodium urate deposits in the tissue

Question 2

Where can monosodium urate depost?

Answer 2

Synovial fluids
Tissues
Kidney

Question 3

What is the building block of monosodium urate?

Answer 3

Uric acid

Question 4

What is uric acid?

Answer 4

End of purine metabolism (Over excess consumed in the population)

Question 5

What is the function of Uric acid?

Answer 5

Nothing

Question 6

What is overproduction or under excretion of uric acid called?

Answer 6

Hyperuricemia

Question 7

What are the Oxidase inhibitors

Answer 7

Xo inhibitors (Allopurinol, Oxipurinol, Febuxosat.

Question 8

What are the Uric Oxidase used for?

Answer 8

Takes uric acid to allantoin

Question 9

What are the two Uric Oxidase inhibitors?

Answer 9

Rasburicase
Peg-uricase

Question 10

What is Hyperurecemia?

Answer 10

Serum uric acid concentration over 420umol/min

Question 11

What is generally the solubility of uric acid in the synovial space?

Answer 11

420 hence anything higher can cause it to supersaturate

Question 12

What can trigger uric acid to precipitate?

Answer 12

Low temperatures and trauma

Question 13

How does overproduction of uric acid occur>?

Answer 13

Overconsumption of rich in purine food,
Obesity
Hypertriglyceridemia

Diuretics
Cytotix drugs

Question 14

How can diuretics lead to hyperuricemia?

Answer 14

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

Question 15

What disease states can lead to hyperuricemia?

Answer 15

CKD
Hypertension
Dehydration

Question 16

What drugs can cause increased uric acid levels?

Answer 16

Alcohol
Ace/ARb
ASA
Cyclosporine
Diuretics
Levodopa
Tacrolimus

Question 17

Take some time to review this figure

Answer 17

This is how uric acid can be secreted in the kidney

Question 18

What clinical situation may we check uric acid levels?

Answer 18

Just for 1 drug that only looks at low levels

Question 19

Excretion of ___/24 hours means an overproducer

Answer 19

1000mg

Question 20

What is the prevelance of Gout>?

Answer 20

3% of world

Question 21

What is the presentation of gout? (4)

Answer 21

Asymptomatic hyperuricemia
Acute gout arthritis
Intercriticial gout
Chronic tophaceous gout

Question 22

What is Asymptomatic hyperuricemia?

Answer 22

Greater then 420 level and the majority do not require drug treatment

Generally an incidental finding though

Question 23

Potential consequence of Asymptomatic hyperuricemia?

Answer 23

Gout
Urate nephropathy
Nephrolitiasis
CKD

Question 24

What is acute gouty arthritis?

Answer 24

Can happen in any join 90% of single joint occurs for first attack

Question 25

What are the possible triggers of gout attack?

Answer 25

Question 26

In general anything that causes a rapid change in ___ leads to gout

Answer 26

Uric acid concentrations

Question 27

What is the intercritical gout stage?

Answer 27

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

Question 28

What is CHronic tophaceous gout?

Answer 28

Tophi are uric acid depoists, late complicaiton of hyperuricemia

Question 29

What are to complications of Gout complications?

Answer 29

Nephrolithiasis
Urate nephropathy

Question 30

Review the next chart

Question 31

What are the lab tests that are generally used for gout?

Answer 31

CBC
Urinalysis
BUN serum uric acid levels
Diagnosis is mainly based off of the symptoms