Gout Flashcards
what is gout?
- uric acid crystals deposit in joints
- crystal induced (uric-acid) Joint damage
there are 2 types of gout
-primary & secondary
uric acid is a by product of what?
purine metabolism, but is usually excreted by kidneys
what are purines & what are pyrimidines
purines: adenine & guanine (nitrogenous bases in DNA, metabolism then causes uric acid formation
pyrimidines: T&C (nitrogenous bases in DNA)
primary gout accounts for _____% of gout
90%
Primary gout
- approx 95% in men
- metabolic disease(metabolic issue with purines) (producing more uric acid then should)
- familial (if in family has higher chance)
Secondary gout
- far less prevalent
- producing normal amount of uric acid then cannot excrete (problem with excretion)
- renal (is leading cause of problem) (renal not excreting uric acid)
- cell destruction(second leading cause) (will lead to excess uric acid ex. leukemia excessive cell turnover)
- others (chemotherapy, excessive alcohol-alcohol inhibits excretion of uric acid causing a build-up in circulation-particularity beer has high purine content)
what is the patho of gout
- alternate purine metabolism causing asymptomatic hyperuricemia (elevated uric acid in blood)
- then crystals deposit in synovial joints (solubility of uric acid is higher in blood, less so in synovial fluid) that is why it crystallizes
- WBC influx & complement activation (POLUMORPHONUCLEAR LEUKOCYTES -move in & remove crystals) Inflammation & damage, cell releases contents, lysosomal enzyme release
- WBC phagocytize crystals which cause WBC necrosis then enzyme is released (lysosomal enzymes) causing inflammation & joint damage
- recurrent acute attacks -formation of tophi (space occupying lesion in joint-hard nodules inside joint)
what are the stages of gout
- hyperuricemia (asymptomatic) (early onest, 30-40 yrs of age)
- acute inflm in 1 joint (usually large toe joint)
triggers acute onset of inflm:
-food
-alcohol
-drugs
-strenuous exercise - subsides in approx 1 wk (swelling & inflm)
- asymptomatic (months-years)
- Frequent, recurrent attack causing permanent damage
why does uric acid crystallize in synovial joints but not in blood?
uric acid is easily soluble in blood (high solubility), synovial fluid (low solubility uric acid crystallizes in there, temps is higher at core & blood more soluble at higher temp (toe lower temp and less prefused)
what does the recurrent acute attacks of gout cause?
formation of Tophi (plural) or Tophus (singular)
which is a space occupying lesion in joint (with hard nodules inside)
diagnosing gout
- hyperurecemia (uric acid) in serum & urine(is not diagnostic)
- crystals in joints (confirmed by x-ray)
what are some of the triggers for acute onset of inflammation with gout?
- food (protein breakdown generates nitrogenous waste products makes nitrogenous waste products hyperurcemia)
- drugs (may have metabolic side effects that affect hyperurcemia
- alcohol (high purine content, ingest lots, metabolize purines, have hyperurcemia & advance)
- strenuous exercise (strenuous activity, increases demand for energy once carbohydrates exhausted break down proteins & nitrogenous waste products)
treatment of gout
- acute attack will have pain & inflammation :
- NSAIDS
- Steroids (anti-inflammatory)
- colchicine (primary property is inhibiits migration of poleymorphonuclear leukocytes, also an anti-inflammatory also an anitmitoitic
treatment of gout
- acute attack will have pain & inflammation :
- NSAIDS
- Steroids (anti-inflammatory)
- colchicine (primary property is inhibiits migration of poleymorphonuclear leukocytes, also an anti-inflammatory also an anitmitotic-this property becomes a side effect because not trying to affect mitosis would likely not be a problem because using short term)
long term:
- decrease hyperurcemia (with drugs)
- Increase uric acid excretion (drugs)
- simple increase fluid intake, excrete more urine, excrete more uric acid (not able to only do this)
- decrease protein in diet (breakdown protein cause increase in uric acid, debatable/controversial contribution of protein breakdown limited)
- no alcohol (particularly beer)