Gout

Question 1

What is gout?

Answer 1

A type of inflammatory arthritis that causes pain, discomfort and damage to joints

Question 2

What causes gout?

Answer 2

Deposition of monosodium urate crystals formed by excess uric acid. The crystals are formed from excess uric acid.

Question 3

What is uric acid?

Answer 3

Breakdown product of purine

Question 4

What are the risk factors for developing gout?

Answer 4

• Genetic predisposition
• Medicines that raise uric acid
• Obesity
• Weight gain
• Hypertension
• Dyslipidaemia
• Alcohol consumption

Question 5

Which drugs lead to raised uric acid levels?

Answer 5

• Aspirin
• Ciclosporin
• Cytotoxic medicines
• Diuretics
• Ethambutol
• Levodopa
• Pyreizinamide
• Ribavaran
• Interferon
• Teriparatide

Question 6

What is the first line treatment for gout?

Answer 6

NSAIDs - start at high dose then taper 24 hours after resolution of attack

Question 7

Which drug can be used in gout patients when NSAIDs are contraindicated?

Answer 7

Colchicine

Question 8

How does Colchicine work?

Answer 8

Arrests assemble of microtubules in neutrophils and inhibits many cellular functions

Question 9

What are the side effects of colchicine?

Answer 9

• Abdominal cramps

- Nausea & vomiting

Question 10

When should colchine be used with caution?

Answer 10

In chronic heart failure patients - can constrict blood vessels and stimulate central vasomotor

Question 11

When would a corticosteroid be used in gout patients?

Answer 11

When NSAIDs and colchicine are contraindicated or ineffective

Question 12

Give examples of corticosteroids used in gout

Answer 12

• Methlypredinisolone acetate

- Triacinalone acetonide

Question 13

What the aim of gout prophylaxis?

Answer 13

Aim is to maintain serum uric acid levels below saturation point of monosodium urate - if serum rate is low then crystal deposits dissolves

Question 14

Which drugs can be used prophylactically in gout patients?

Answer 14

• Allopurinol
• Febuxostat
• Uricosuric medicines: Benzbromarone and Pegloticase

Question 15

How does allopurinol work?

Answer 15

Inhibits xanthine oxidase which reduces production of uric acid

Question 16

What dose of allopurinol should be given to patients with normal renal function?

Answer 16

100mg daily and increase every 2/3 weeks till optimum serum levels are reached

Question 17

What does allopurinol interact with?

Answer 17

Azathioprine

Mercaptopurine

Question 18

Which patients is febuxostat indicated for?

Answer 18

Patients with chronic hyperuricaemia

Question 19

What are the potential ADRs associated with febuxostat?

Answer 19

• Respiratory infection
• Nausea
• Diarrhoea
• Headache
• Liver function abnormalities

Question 20

How do uricosuric medicines work?

Answer 20

Increase excretion of gout

Question 21

Give examples of uricosuric medicines.

Answer 21

Sulphinpyrazone
Probenacid
Benzbromarone
Pegloticase

Question 22

Which lifestyle changes should be considered in gout patients?

Answer 22

• Moderate physical exercise
• Weight loss
• Purine intake shouldn’t exceed 200mg a day
• Avoid: shellfish, offal and sardines
• Reduce alcohol intake

Question 23

What proportion of gout patients have hypertriglyceridaemia?

Answer 23

25%

Question 24

What are tophi?

Answer 24

White/yellow bumps beneath the skin due to deposition of uric acid

Question 25

What is bursa? What occurs when tophi shed into the bursa?

Answer 25

Bursa are the synovial fluid sacs surrounding joints. When uric acid crystals shed into the bursa, an inflammatory response occurs.

Question 26

What is the most common site of gout infection?

Answer 26

Interdigital toe space (first metatarsopharangeal joint)

Question 27

When is prophylactic treatment started?

Answer 27

2-3 weeks after an acute attack completely resolves