Gout

Question 1

What is uric acid a byproduct of?

Answer 1

Purine metabolism

Question 2

What serum levels define hyperurecemia?

Answer 2

Levels greater than 7 mg/dL

Question 3

What are two ways we can target hyperurecemia?

Answer 3

Inhibiting xanthine oxidase

Prevent reabsorption

Question 4

Describe the pathway of developing gouty arthritis.

Answer 4

Hyperuricemia leads to precipitation of monosodium urate (MSU). These MSU crystals lead to inflammation.

Question 5

Name risk factors for Gout.

Answer 5

Hyperuricemia
Male
High purine diet (red meats, shellfish)
Beer and alcohol
Obesity and the metabolic syndrome
CKD
Solid organ transplantation
Medications

Question 6

Name medications that can lead to gouty arthritis

Answer 6

Diuretics (thiazides, loops)
Calcineurin inhibitors
Low-dose salicylates
Niacin (vitamin B3)

Question 7

Describe Acute Gouty Arthritis “Flare”

Answer 7

Severe pain, fever, warmth/swelling

Usually monoarticular
With or without tophi

Rapid onset and lasts for about 3-10 days

Question 8

Chronic Gouty Arthritis

Answer 8

Polyarticular
Tophi (urate cyrstal aggregates)
Nephropathy in severe cases

Question 9

How long do you wait to start ULT after an acute attack?

Answer 9

6-8 weeks

Question 10

How do you treat severe pain?

Answer 10

Combination therapy