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Yr 3 Inflammatory and GI > Gout and Osteoarththritis > Flashcards

Gout and Osteoarththritis Flashcards

1
Q

What is osteoarthritis

A

Disorder of joints- articular cartilage loss and accompanying periarticular bone response
Can affect any joint- knee common

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2
Q

What happens during osteoarthritis? pathophysiology

A

Rate of damage exceeds rate of repair
Cycle of degeneration -> exposes bone to more load causing more damage
Loss of cartilage and growth of osteophytes
Narrowing of joint space
causes Synovitis and effusion

(Osteophytes concentrated at joint, cartilage thins between joints, capsule around inflamed synovium is thickened and tight.

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3
Q

What are the risks of osteoporosis?

A

age- Over 45
obesity - BMI over 25
gender - female
Occupation - physically demanding

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4
Q

How do you diagnose osteoporosis?

A

Symptoms- Activity related joint pain
- Morning stiffness no longer than 30 mins
- muscle wasting
- hands with ‘nodes’
Diagnoses without investigations: activity related joint pain and stiffness in morning no longer than 30 mins or over 45yrs old.
Xrays and blood tests help aid.

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5
Q

How do you manage Osteoarthritis?

A

Holistic approach!
Lifestyle choices- weight loss, exercise, physical aids
Pain relief-
Topical NSAID’s or capsaicin
Paracetamol
Oral NSAID’s (and PPI)
Opioids
Intra-articular corticosteroids
surgeries

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6
Q

What is GOUT?

A

Hyperuricaemia
either by increased production or decreased excretion of uric acid from kidney.

Deposition of monosodium urate monohydrate crystals in joints and tissues causing inflammation and tissue damage.

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7
Q

How is uric acid synthesized

A

Purine metabolism
Hypoxanthine-> xanthine -> uric acid

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8
Q

How is uric acid secreted?

A

Filtered by glomerulus
50% excreted in distal tubule.
2/3 of urate excreted in urine
1/3 in GI tract

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9
Q

Why is uric acid under excreted from kidneys?

A

Most likely cause of gout
Hyperuricaemia-> high conc. of urate loads filtered thru. glomerulus-> increased reabsorption to avoid dumping insoluble urate into urinary tract

Caused by:
Renal failure, Alcohol, drugs (diuretics, aspirin, ciclosporin, omeprazole, etc), or physical stress

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10
Q

What is the pathophysiology of gout?

A

Hyperuricaemia
Formation and deposition of monosodium urate crystals more likely when over 380micromol/ml

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11
Q

How is monosodium urate formed

A

Uric acid at physiological pH is ionised

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12
Q

when do symptoms of gout start presenting?

A

When urate crystals shed into bursa (synovial fluid) causing an inflammatory reaction
causes proinflammatory cascade of cytokines, chemotactic factors and TNF

IL-1beta related to inflammation in gout

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13
Q

What are the 5 stages of Gout?

A

Asymptomatic hyperuricaemia
Acute gouty arthritis
intercritical gout
Chronic tophaceous gout
Gouty nephropathy

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14
Q

What is intercritical gout?

A

Time between gout attacks

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15
Q

What is Acute gouty arthritis?

A

Begins abruptly 8-12hrs
usually in joint of great toe
weight baring impossible

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16
Q

What is Chronic tophaceous gout?

A

Presence of tophi
white deposits of monosodium urate
Nodules
can be in earlobes tendons etc

17
Q

What is Gouty nephropathy?

A

Urate crystals deposited around renal tubules in kidney
Causes inflammation
Causes proteinuria and renal impairment
Renal stones

18
Q

How do you diagnose Gout?

A

Joint fluid microscopy- crystals and absence of infection (rule out septic arthritis)
Joint x-ray
Blood tests for RF, lipids, glucose

19
Q

How to treat an acute attack of gout?

A

rest
full dose NSAID’s
Avoid aspirin as competes for excretion w/ uric acid

20
Q

What’s 1st line for gout

A

NSAID’s
Consider lansoprazole
24-48hrs high dose, lower dose 7-10 days

21
Q

When is Colchicine used for gout

A

used 2nd line when NSAIDs CI
eg: for CVD, renal disease, GI toxicity

22
Q

How does colchicine work

A

Slower onset than NSAIDs
Inhibits neutrophil migration to joint

23
Q

colchicine dose

A

0.5mg 2-4x a day until relief/ SE/ total 6mgg taken
Don’t repeat within 3 days

Elderly- 0.5mg every 8hrs

24
Q

Side effects of colchicine

A

Nausea and vomiting
Diarrhoea- stop IMMEDIATELY

25
Q

What treats a flare of gout?

A

Corticosteroids
prednisolone 30-35mg a day (5x days for flare)

Articular- triamcinolone

26
Q

What is combo therapy for gout

A

NSAID’s with colchicine or corticosteroid

27
Q

What is used as prophylaxis for gout

A

Urate lowering therapy

28
Q

When is prophylaxis for gout considered

A

2 or more acute attacks a year, tophi, chronic gouty arthritis, joint damage, renal impairment, diuretics, young onset

Don’t start during acute attack as causes changes of uric acid levels causing mobilisation of stores and may precipitate another attack/prolong attack

29
Q

What is given as prophylaxis for gout

A

allopurinol
and colchicine (0.5-1mg a day) for first 6 months of ULT or during dose titration (so keep colchicine until 360micromol/l target reached)

30
Q

How does allopurinol work for gout?

A

Xanthine oxidase inhibitor
prodrug (oxipurinol)

31
Q

Dose of allopurinol?

A

100mg a day increase every 3-4 weeks
Usually 300mg a day

32
Q

What is febuxostat?

A

Non-purine selective inhibitor of xanthine oxidase
An alternative to allopurinol

33
Q

Dose of febuxostat?

A

80mg a day (can be up to 120mg )

34
Q

What is second line to allopurinol and febuxostat for gout?

A

Sulfinpyrazone
Uricosuric agents
Increases uric acid secretion by direct action on renal tubule

35
Q

when are Uricosuric agents CI?

A

If poor renal function (crcl less than 20-30)
Maintain water intake
Urate nephropathy

36
Q

What has a severe interaction with allopurinol

A

Azathioprine
May cause bone marrow suppression as accumulation of allopurinol

Yr 3 Inflammatory and GI (15 decks)

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