Gout Flashcards
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Hyperuricemia
Formation of uric crystals inside and around the joint
Symptoms
• red/inflammation
• hot to touch
• red shiny skin
As the swelling goes down what happens to the skin of affected joint
Flakey, itchy, peeling
Which joint is affected first?
Metatarsophalangeal joint - MTP
Which joints can be affected?
• big toe
• ankles
• fingers
• elbows
• knees
Is the onset rapid or slow
Rapid - will occur in a few hours and last for 3-10 days
Causes
• disruption in the metabolism of purines
• hyperuricemia
What are purines made from (atoms)
Carbon and nitrogen
Where are they found in the body of living things
Nucleus - DNA and RNA
Foods with high content of purines which should be avoided?
• sea food
• kidneys, liver and heart
Foods with medium content of purines which should be avoided?
Meat - beef, lamb, pork
Beer
Foods with low content of purines which should be avoided?
Dairy foods
Carbs
When alcohol is being metabolised what happens to urate
It contributes to the retention of uriate
(Alcohol also contributes to obesity which can under excretion of urate
Gout risk factors
• men
• post menopausal women >45
• CVD, HTN, diabeties
• obesity, hyperlipidemia
• drugs - thiazide diuretics, low dose aspirin
Stages of Gout - asymptomatic
Long periods of no asymptomatic Hyperuricemia before gout occurs
Stage - acute
Sudden onset of pain and swelling lasts 3-10 days
Stages - Intercritical gout
The period between gout attacks (can be 10 years) whilst there’s this formation of crystals
Stages - Chronic
Permanent damage
Which test are used
• serum uric acid (wait 2-4 weeks after attack because uric acid levels are not raised during attacks)
^this shouldn’t be used alone
Joint aspiration and microscopy of synovial fluid OR X-ray, CT, ultrasound
Which urate level indicate gouts
> 360
What is the treatment of acute gout
1st - NSAIDs - ibuprofen or Naproxen
(Give PPI)
2nd - Colchicine
3rd
- oral prednisone
- IM methylprednisolone
Colchicine MOA
Inhibitors activation of neutrophils
When should acute treatment be started
ASAP
How long after attack has resolved should it be continues for?
48 hours
Who may not NSAIDs be suitable for
• HF
• hx of peptic ulcers
• on anticoagulants- warfarin
Which drug would be suite in acute gout with HF
Colchicine
Which drugs interact with colchicine
CYP4A3 inhibitors
Examples -
• vir - HIV drugs
• zole - antifungals
• clarythromycin
A side effect of colchicine is gi upset how would you councel a patient on this
Take with or after food
What sort of patients can receive treatment if chronic gout/prevtion
ULT - uric acid lowering therapy
• CKD 3-5
• 2+ flares in one year
• tophi
• on diuretics
What is the MOA ULT
Xanithine oxidase inhibitors
1st and 2nd line ?
Allopurinol
And
Febuxostat
What is the max dose of of Allopurolol
900mg/day
How long after would you monitor sUA
4 weeks
(If over 360 increase dose)
Same for febuxostat
What should be co prescribed for both ULT
Colchicine 500mcg BD for 6 months
What is a common side effect of Allopurinol
Hypersensitive rash
Should it be continued after this rash
No STOP
What does Allopurolol interact with
Azithroprine, mercaptropurine, ACEI or thiazide and amoxicillin
What does Febuxostat interact with
Azithroprine and Mercaptopurine
What complications can occur?
• renal stones
• chronic arthritis
• tophi
Can ULT continued if gout attacks occurs
Yes treat attack separately
In acute gout treatment for someone with reduced eGFR what should be given
Colchicine
What is the most definite test for foot
Joint aspiration and microscopy of synovial fluid
What is the target sUA levels in foot
<300
Example of a uricosuric agent
Probenecid
Which monitoring is key in ULT
Creatin and renal
