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Clinical Medicine Ortho > Gout > Flashcards

Gout Flashcards

1
Q

What is gout?

A

Urate saturation in the body tissues

Forms monosodium urate crystals (MSU)

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2
Q

What is the presentation of gout?

A

Intermittent, monoarthtritis in lower extremity

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3
Q

What can gout progress to?

A

Polyarthritis that typically affects peripheral joints

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4
Q

What are the phases of gout?

A
  1. Asymptomatic hyperuricemia
    - Serum urate concentration > 7mg/dL
    - +/- symptoms
  2. Acute gouty arthritis
  3. Intercritical gout
    - Intervals between attacks
  4. Chronic tophaceous gout
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5
Q

What does gout have a direct coorelation with?

A

Increased serum urate and likelihood of developing gout

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6
Q

What is the biggest epidemiology associated with gout?

A

Hyperuricemia

- Prevalence: 15-20%

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7
Q

What are some emedimiology issues with gout?

A

Women after menopause
HTN
Renal Insufficiency
Diuertic exposure

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8
Q

What are the risk factors associated with hyperuricemia?

A

Greater prevalence of

  • HTN
  • Metabolic syndrome
  • Obesity

Thiazide diuretics and low dose ASA

Changes in diet

  • High Purine diet
  • High-fructose corn syrup
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9
Q

What are the dietery factors associated with gout?

A

Purine rich foods
Alcohol consumption
Fructose and sugar sweetened drinks

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10
Q

What are the protective dietery foods associated with gout?

A

Vitamin C
Coffee
Cherries

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11
Q

What are the causes of gout?

A

Purine metabolism produces uric acid

  • Underexcretion *90%
  • Overproduction
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12
Q

What are the causes of underexcretion?

A 
Reduced GFR/Kidney disease
Hypertension
Obesity
Diuretics
Alcohol
ASA
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13
Q

What are the causes of overproduction?

A 
Metabolic disorders 
Obesity
Psoriasis
- Accelerated cell turnover releases purines
Nicotinic acid (B3)
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14
Q

What is the presentation of gout?

A

Sudden onset of pain
Cardinal signs of inflammation
+/- constitutional symptoms

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15
Q

What happens in the initial attack of gout?

A

Monoarticular

Lower extremity joints

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16
Q

Where does gout my commonly occur?

A

1st metatarsophalangeal joint (Podagra)
Ankle
Midfoot
Knee

17
Q

What happens in the advanced attack of gout?

A

Subcutaneous tophus
Urate kidney stones
Joint damage
Poly-articular attacks

18
Q

What is the gold standard of diagnosisng gout?

A

Synovial fluid analysis with intracellular needle-shaped crystals with strong negative birefringence

19
Q

What is the treatment for acute attacks of gout?

A 
RICE
NSAIDs 
Colchicine
Corticosteriods
\+/- opioids
20
Q

What is the treatment for recurrent/advanced gout?

A

Urate lowering therapy

Allopurinol; febuxostat

  • Xanthine oxidase inhibitor (overproducers and underexcreaters)
  • Blocks uric acid production

Probenecid
- Increases renal excretion of uric acid (underexcreaters)

Pegloticase
- Converts uric acid to allantoin- readily excreted by kidneys
- IV/Blackbox warning
anaphylaxis

Clinical Medicine Ortho (42 decks)

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