Gout Flashcards
what is gout considered?
a crystal induced arthropathy
what type of crystals cause gout
monosodium urate monohydrate crystals
where can the crystals deposit?
joint, bursae, tendon
are males or females more affected? age?
males
30-60
when tissues become supersaturated, the urate salts precipitate, in the form of needle-like crystals called….
NEGATIVE BIFRINGENT CRYSTALS
what is the role of the WBCs
they attack the negative bifringent crystals and cause an acute attack
uric acid is an end-stage by-product of what?
purine metabolism
how do humans normally remove uric acid
renal metabolism
when might hyperuricemia develop
when the saturation level of uric acid drops below 6.8mg/dL in the urine. then it’’ deposit in the soft tissues
what are the two reasons for accumulation of urate?
over producers (10%) underexcreters (90%)
what are the RFs for over producers
overconsumption of purines (seafood, meat, fructose, soft drinks, wine) OR production of excessive amts of uric acid endogenously ETOH myeloproliferative d/o psoriasis hemolytic anemia cell lysis-chemotherapy excessive exercise
what are the reasons for someone to be an underexcreter?
inability to excrete uric acid in the urine medications kidney dz starvation dehydration chronic ETOH use
what causes an acute flare?
an acute increase or decrease in urate levels that may lead to the production, exposure of shedding of crystals
what can cause changes in levels of urate?
acute alcohol ingestion
acute overindulgence in high purine foods
rapid weight loss
dehydration
can gout be genetic?
yes! 3 genes thought to be involved
what is the MC presentation?
when does it reach max intensity?
when does it improve?
commonly starts as monoarticular
1st MTP - “Podagra”
12-24 hrs
improvement of sx within days to weeks
what might you see on a severe attack (hint: it might look similar to a septic arthritis)
severe pain, redness, warmth, swelling
+/- fever
you may have arthritis at other sites (finger joints, instep, ankle, knee)
what can happen to attacks over time?
they become more severe and polyarticular over time
what if attacks are left untreated?
they become more frequent and abate more slowly with time
what is the stage of gout when they “get out of their attack”
intercritical gout
20 years of untreated urate deposition can lead to
chronic tophaceous gout
what are tophi
urate crystal masses surrounded my inflammatory cells and fibrosis
what are the characteristics of the tophi
firm, movable, yellowish. they ulcerate with chalky material
where are some common places to have tophi
pinna of the ear over involved joints extensor surfaces of the forearm olecranona infrapatellar Achilles tendon
