Gout and Hyperuricemia Day 1 Flashcards

1
Q

What is Gout?

A

hyperuricemia. It is recurrent attacks of aacute arthritis associated with urate crystals in synovial fluid. The crystals deposit in tissues in and around joints. It is an intestinal renal disease. It is uric acid nephrolithiasis

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2
Q

What is the epidemiology of gout?

A

men>women
peak 30 - 50 years
“disease of kings”

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3
Q

What are the risk factors of Gout?

A
older are
male
hyperuricemia
obesity
HTN
DM
CKD
Alcohol intake 
high red meat or fish intake
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4
Q

What is the pathophysiology of uric acid?

A

produced from purine degradation. It is a waste product with no physiologic purpose

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5
Q

What is the pathophysiology of uricase?

A

enzyme that breaks down uric acid into soluble allantoin

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6
Q

What does hyperuricemia occur from?

A

overproduction of uric acid and underexcretion of uric acid

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7
Q

What 3 sources do purines come from?

A

diet
conversion of nucleic acid to purine nucleotides
De Novo synthesis of purine bases

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8
Q

What can cause an over production of uric acid?

A

purines and 2 enzyme abnormalities

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9
Q

What causes under excretion on uric acid?

A

multiple factors

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10
Q

How does uric acid get eliminated?

A

urine and enzyme break down in GI tract

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11
Q

What is urine excretion determined by?

A

Glomerular excretion
tubular secreation
tubular reabsorption
postsecretory reabsorption

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12
Q

What medications that decrease Uric acid excretion?

A
diuretics
nicotinic acid
salicylates
ethanol
pyrazinamide
levodopa
ethambutol
cytotoxic drugs
cyclosporine
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13
Q

How do you evaluate hyperuricemia?

A

determine if over producer or underexcretor

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14
Q

What determines if you are an underexcretor of uric acid?

A

purine free diet for 3-5 days and <600 mg/day excreted

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15
Q

What determines if you are an overproducer of uric acid?

A

purine free diet for 3-5 days and >600 mg/day excreted

Normal diet with an excretion of >1000 mg/day

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16
Q

What is the clinical presentation of acute gouty arthritis?

A

rapid onset (night)
excrusciating pain, swelling, inflammation, redness, fever
monoarticular early on (big toe, ankles, heel, wrist finger)
podagra
resolves in 3-14 days

17
Q

What are precipitating factors of Acute gouty arthritis?

A

stress, trauma, alcohol injestion, infection, surgery, rapid lowering of serum uric acid, medications

18
Q

What is the clinical presentation of atypical presentation?

A

chronic polyarticular arthritis

multiple small joints in hands

19
Q

What is the clinical presentation of Tophaceous gout?

A
late complications (10 yrs to develop)
urate crystals deposit in soft tissue
sites (helix of ear, wrist, hands, elbow, olecranon bursae, achilles tendon, base of big toe)
pain, tissue and joint damage and deformity, nerve complications
20
Q

What is the risk factors of uric acid neophrolithiasis?

A

overexcreter
acidic urine
highly concentrated urine

21
Q

What is uric acid nephropathy?

A

acute renal failure

urine flow blockage due to collection of uric acid crystals in collecting ducts and ureters

22
Q

What is chronic urate nephropathy?

A

long term deposits of urate in renal parenchyma

23
Q

What are the sign/symptoms of chronic urate nephropathy?

A

decreased ability to concentrate urine
proteinuria
HTN
Nephrosclerosis

24
Q

What is the only definitive diagnosis of gout?

A

synovial fluid aspirate containg urate crystals

25
Q

What do you need to consider for a clinical diagnosis for gout?

A

more than 1 attack of acute arthritis
max inflammation within 1 day
monoarthritis attack
redness over joints
1st metatarsophalangeal joint painful or swollen
nilateral 1st metatarsophalangeal joint attack
tophus
hyperuricemia
asymmetric swelling within joint on xray
subcortical cysts w/o erosions on xray
urate monohydrate microcrystals in joint fluid
joint fluid cultrue negative for organisms

26
Q

What are the diagnositic tools for gout?

A

radiograph (changes with long standing)

MRI and CT and not typical

27
Q

When do you use acute treatment?

A

for current gout flare

28
Q

When do you use chronic treatment?

A

frequent flares (>1/ year)
presence in 1 or more typhus
CKD Stage 2 or worse
history of urolithiasis

29
Q

What are the treatment goals of gout?

A

terminiate acute attack
prevent recurrent attacks (want serum uric acid <6)
prevent complications

30
Q

What are the non pharmacologic treatment options?

A

joint rest and ice for acute attack
reduce intake of saturated fat and purines
decrease salt intake
decrease alcohol intake
wt loss and excercise
correct underlying causes (hyperlipidemia and insulin resistance)
smoking cessation

31
Q

What do you use to treat acute gout attacks?

A

NSAIDS
Colchicine
corticosteroids

32
Q

What do you use to treat chronic management?

A

Xanthine oxidase inhibitors
uricosurics
pegloticase

33
Q

What it the best time to initiate therapy?

A

within 24 hours of onset