Gout Flashcards
What is gout?
A type of inflammatory arthritis that causes pain, discomfort and damage to joints
What causes gout?
Deposition of monosodium urate crystals formed by excess uric acid. The crystals are formed from excess uric acid.
What is uric acid?
Breakdown product of purine
What are the risk factors for developing gout?
- Genetic predisposition
- Medicines that raise uric acid
- Obesity
- Weight gain
- Hypertension
- Dyslipidaemia
- Alcohol consumption
Which drugs lead to raised uric acid levels?
- Aspirin
- Ciclosporin
- Cytotoxic medicines
- Diuretics
- Ethambutol
- Levodopa
- Pyreizinamide
- Ribavaran
- Interferon
- Teriparatide
What is the first line treatment for gout?
NSAIDs - start at high dose then taper 24 hours after resolution of attack
Which drug can be used in gout patients when NSAIDs are contraindicated?
Colchicine
How does Colchicine work?
Arrests assemble of microtubules in neutrophils and inhibits many cellular functions
What are the side effects of colchicine?
- Abdominal cramps
- Nausea & vomiting
When should colchine be used with caution?
In chronic heart failure patients - can constrict blood vessels and stimulate central vasomotor
When would a corticosteroid be used in gout patients?
When NSAIDs and colchicine are contraindicated or ineffective
Give examples of corticosteroids used in gout
- Methlypredinisolone acetate
- Triacinalone acetonide
What the aim of gout prophylaxis?
Aim is to maintain serum uric acid levels below saturation point of monosodium urate - if serum rate is low then crystal deposits dissolves
Which drugs can be used prophylactically in gout patients?
- Allopurinol
- Febuxostat
- Uricosuric medicines: Benzbromarone and Pegloticase
How does allopurinol work?
Inhibits xanthine oxidase which reduces production of uric acid
What dose of allopurinol should be given to patients with normal renal function?
100mg daily and increase every 2/3 weeks till optimum serum levels are reached
What does allopurinol interact with?
Azathioprine
Mercaptopurine
Which patients is febuxostat indicated for?
Patients with chronic hyperuricaemia
What are the potential ADRs associated with febuxostat?
- Respiratory infection
- Nausea
- Diarrhoea
- Headache
- Liver function abnormalities
How do uricosuric medicines work?
Increase excretion of gout
Give examples of uricosuric medicines.
Sulphinpyrazone
Probenacid
Benzbromarone
Pegloticase
Which lifestyle changes should be considered in gout patients?
- Moderate physical exercise
- Weight loss
- Purine intake shouldn’t exceed 200mg a day
- Avoid: shellfish, offal and sardines
- Reduce alcohol intake
What proportion of gout patients have hypertriglyceridaemia?
25%
What are tophi?
White/yellow bumps beneath the skin due to deposition of uric acid
What is bursa? What occurs when tophi shed into the bursa?
Bursa are the synovial fluid sacs surrounding joints. When uric acid crystals shed into the bursa, an inflammatory response occurs.
What is the most common site of gout infection?
Interdigital toe space (first metatarsopharangeal joint)
When is prophylactic treatment started?
2-3 weeks after an acute attack completely resolves
