Gout Flashcards
What is gout?
Gout is the most common inflammatory arthritis in the United States, characterized by metabolic disorder and inflammation due to monosodium urate crystal deposition around the joints.
What are the two distinct processes involved in the pathogenesis of gout?
- Metabolic disorder marked by deposition of monosodium urate crystals.
- Inflammatory response to the formed crystals.
What is hyperuricemia?
Hyperuricemia is an excess of uric acid in the blood, often associated with gout.
What is the relationship between uric acid levels and gout attacks?
Typically, higher uric acid levels and longer elevation increase the likelihood of gout and tophi formation.
True or False: All patients with hyperuricemia develop gout.
False. Some patients with hyperuricemia do not develop gout, while others with gout may have normal or low uric acid levels.
What characterizes primary gout?
Primary gout is characterized by hyperuricemia due to overproduction of uric acid, decreased urate excretion, or both.
What percentage of patients with gout have hyperuricemia due to urate overproduction?
Less than 5%.
What is secondary gout associated with?
Secondary gout is related to diseases or drugs that affect uric acid excretion or production.
List some conditions associated with secondary gout.
- Diabetic ketoacidosis
- Severe dieting or starvation
- Metabolic syndrome
- Chronic kidney disease
- Multiple myeloma and leukemia
What role do diuretics play in gout?
Diuretics can contribute to uric acid underexcretion, leading to gout.
What is the biologic value recommended for hyperuricemia?
6.8 mg/dL or 408 umol/L.
What triggers an attack of gout?
Sudden increases or decreases in serum uric acid levels lead to gout attacks.
What are the four phases of gout?
- Asymptomatic hyperuricemia
- Acute gouty arthritis
- Intercritical or interval gout
- Chronic tophaceous gout
What is podagra?
Podagra is the acute gouty arthritis affecting the metatarsophalangeal (MTP) joint of the big toe.
What are tophi?
Tophi are deposits of uric acid crystals that form in and around joints, skin, and other tissues.
What imaging methods can assist with gout diagnosis?
Ultrasound and dual energy CT scan.
What is the purpose of NSAIDs in acute gout management?
NSAIDs relieve pain and inflammation during acute gout attacks.
Name some NSAIDs used for acute gout.
- Indomethacin
- Naproxen
- Ibuprofen
What is the role of colchicine in gout treatment?
Colchicine is effective for acute attacks, reducing inflammation by lowering uric acid deposition.
What are urate-lowering therapies (ULT)?
ULTs aim to reduce uric acid levels to prevent gout attacks.
Name two medications used for urate-lowering therapy.
- Allopurinol
- Febuxostat
What dietary changes can help manage gout?
Limit purine-rich foods and alcohol consumption.
Foods rich in purines include:
Organ meats: liver, kidneys, sweetbreads, and brain.
Seafood:
anchovies, sardines, mussels, oysters, lobster, shrimp, and scallops.
Meat:
beef, lamb, pork, venison, chicken, and turkey.
Other foods:
Yeast extract, Gravy, Beer, Wine, Sugary drinks, Mushrooms, Peas, and Asparagus.
What is the recommended fluid intake for gout patients?
Eight to sixteen cups of fluid daily.
What is the goal of monitoring serum uric acid levels in gout treatment?
To ensure levels are below the target (usually <6 mg/dL) and adjust treatment as needed.
What lifestyle modifications can help prevent gout attacks?
- Weight management
- Regular exercise
- Avoiding triggers
What should patients be educated about regarding gout?
- Recognizing symptoms
- Medication adherence
- Avoiding triggers
What is the importance of follow-up care in gout management?
Regular follow-up helps monitor uric acid levels and adjust treatment as necessary.
What are the clinical manifestations of gout syndrome?
- Acute gouty arthritis
- Tophi
- Gouty nephropathy
- Uric acid urinary calculi
