Gout

Question 1

what is gout?

Answer 1

crystal deposit in the joints and triggers inflame
crustal-induced joint disease
uric acid deposits in the joints

Question 2

what is primary gout?
prevelance?
gender?

Answer 2

90%
metabolic disease - uric acid has to be formed - if its abnormal or too much
mostly men

Question 3

what is secondary?

Answer 3

relates to a secondary problem from uric acid

other condition where excessive cel turnover, you’ll have uric acid

1. cell destruction (leukaemia) usually cells that proliferate regularly
2. could be kidney not functioning and uric acid builds up in the blood
3. others (alcohol -beer, receiving chemo) destroys malignant cells

Question 4

whats the patho

Answer 4

alt purine metb (adenine and guanine) –> asympt hyperuricemia (elevated uric acid in the blood)
when you breakdown purines, byproduct is uric acid
kidney can’t cope with excretion and inc []
later: crsytals deposit in synovial joints
WBC influx and complement activation
-leukocutes come and phagocytize crystals in attempt to remove them- WBC necrosis -E release now E present in the joints and inflam joint damage
-recurrent acute attacks -> tophi (new lesion) - hardening of uric acid in the joint

Question 5

what is the first stage? patho

Answer 5

asympt hyperuricemia

Question 6

what is the second stage?

Answer 6

acute inflm (over night, 1 joint?) wake up with one swollen joint

lets say you ate a lot of food (metb) or drank beer (high purine content) or inc exercise (breakdown of proteins and uric acid is released) you will inc cell turnover

uric acid is more soluble in blood than in synovial fluid so when it gets in there it will crystallize (not in the blood) mostly in the large toe. at night when blood flow is minimized, gives opportunity for things to move out of the blood into the joints

Question 7

stage 3? how long before it subsides?

Answer 7

1 week

Question 8

stage 4?

Answer 8

asymp (mt to years)

Question 9

stage 5?

Answer 9

freq recurrent attacks - perm damage

Question 10

dx?

Answer 10

serum and urine uric aid and uric acid in the joints

Question 11

why can’t you look up hyperuricemia?

Answer 11

bc it can be elevated w/out gout

will have to look at uric acid in the urine

Question 12

tx?

Answer 12

acute attacks? (pain and inflame)
-NSAID
or colchicine (inhibits migration of leukocytes to the joint via chemotaxis)
-or steroids

dec hyperuricemia by
inc uric acid excerpt (water)
dec alc
dec protein