Gout Flashcards
What is gout?
Urate saturation in the body tissues
Forms monosodium urate crystals (MSU)
What is the presentation of gout?
Intermittent, monoarthtritis in lower extremity
What can gout progress to?
Polyarthritis that typically affects peripheral joints
What are the phases of gout?
- Asymptomatic hyperuricemia
- Serum urate concentration > 7mg/dL
- +/- symptoms - Acute gouty arthritis
- Intercritical gout
- Intervals between attacks - Chronic tophaceous gout
What does gout have a direct coorelation with?
Increased serum urate and likelihood of developing gout
What is the biggest epidemiology associated with gout?
Hyperuricemia
- Prevalence: 15-20%
What are some emedimiology issues with gout?
Women after menopause
HTN
Renal Insufficiency
Diuertic exposure
What are the risk factors associated with hyperuricemia?
Greater prevalence of
- HTN
- Metabolic syndrome
- Obesity
Thiazide diuretics and low dose ASA
Changes in diet
- High Purine diet
- High-fructose corn syrup
What are the dietery factors associated with gout?
Purine rich foods
Alcohol consumption
Fructose and sugar sweetened drinks
What are the protective dietery foods associated with gout?
Vitamin C
Coffee
Cherries
What are the causes of gout?
Purine metabolism produces uric acid
- Underexcretion *90%
- Overproduction
What are the causes of underexcretion?
Reduced GFR/Kidney disease Hypertension Obesity Diuretics Alcohol ASA
What are the causes of overproduction?
Metabolic disorders Obesity Psoriasis - Accelerated cell turnover releases purines Nicotinic acid (B3)
What is the presentation of gout?
Sudden onset of pain
Cardinal signs of inflammation
+/- constitutional symptoms
What happens in the initial attack of gout?
Monoarticular
Lower extremity joints
Where does gout my commonly occur?
1st metatarsophalangeal joint (Podagra)
Ankle
Midfoot
Knee
What happens in the advanced attack of gout?
Subcutaneous tophus
Urate kidney stones
Joint damage
Poly-articular attacks
What is the gold standard of diagnosisng gout?
Synovial fluid analysis with intracellular needle-shaped crystals with strong negative birefringence
What is the treatment for acute attacks of gout?
RICE NSAIDs Colchicine Corticosteriods \+/- opioids
What is the treatment for recurrent/advanced gout?
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
