Gout

Question 1

Patho physiology of Gout

5

Answer 1

Purines synethesised into purine nucleotides

Nucleotides break into uric acid

Uric acid secretion insufficient leads to hyper and formation of crystals

Deposit in synovial joints leading to synovitis

Tophi sevelops in soft tissue after long duration

Question 2

Clinical presentation of Gout
X-ray
7

Answer 2

X-ray tophi, cortical erosions, overhanging margins.

Severe pain at night exquisite 
Heat
Red
Swollen
Initial attack painful pressure walking
Symptoms may resolve spontaneously but quicker with treatment

Question 3

Diagnosis of gout

4

Answer 3

Huperuricema
Acute monoarticilar arthritis
Response to colchine
Definite: mono sodium urate in synovial joints or tophi

Question 4

Aims of management for gout

4

Answer 4

Relieve symptoms
Improve function
Improve QoL
Manage uric acid

Question 5

Non pharm treatment of gout

6

Answer 5

Diet
Weight loss
Exercise 
Stop smoking
Hydrate 
Footwear

Question 6

Pharm treatment of gout

For symptoms

Answer 6

Colchicine for acute attacks rapid relief Se dirrohea

NSAIDs ibuprofen

Steroid base predinsolone

Question 7

Pharm treatment of gout

Managing gout

2

Answer 7

Allopurinol - blocks uric acid production

Febuxostat relieved tophi rapidly
Tolerance more Se then allo

Question 8

Aietlogy of gout

4

Answer 8

Mono sodium urate in blood leading to huperuricema

Diet (seafood, alcohol)

Trauma

First attack occurs 10-30 years after huperuricema