Gout and Osteoarththritis Flashcards
What is osteoarthritis
Disorder of joints- articular cartilage loss and accompanying periarticular bone response
Can affect any joint- knee common
What happens during osteoarthritis? pathophysiology
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.
What are the risks of osteoporosis?
age- Over 45
obesity - BMI over 25
gender - female
Occupation - physically demanding
How do you diagnose osteoporosis?
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.
How do you manage Osteoarthritis?
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
What is GOUT?
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.
How is uric acid synthesized
Purine metabolism
Hypoxanthine-> xanthine -> uric acid
How is uric acid secreted?
Filtered by glomerulus
50% excreted in distal tubule.
2/3 of urate excreted in urine
1/3 in GI tract
Why is uric acid under excreted from kidneys?
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
What is the pathophysiology of gout?
Hyperuricaemia
Formation and deposition of monosodium urate crystals more likely when over 380micromol/ml
How is monosodium urate formed
Uric acid at physiological pH is ionised
when do symptoms of gout start presenting?
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
What are the 5 stages of Gout?
Asymptomatic hyperuricaemia
Acute gouty arthritis
intercritical gout
Chronic tophaceous gout
Gouty nephropathy
What is intercritical gout?
Time between gout attacks
What is Acute gouty arthritis?
Begins abruptly 8-12hrs
usually in joint of great toe
weight baring impossible
What is Chronic tophaceous gout?
Presence of tophi
white deposits of monosodium urate
Nodules
can be in earlobes tendons etc
What is Gouty nephropathy?
Urate crystals deposited around renal tubules in kidney
Causes inflammation
Causes proteinuria and renal impairment
Renal stones
How do you diagnose Gout?
Joint fluid microscopy- crystals and absence of infection (rule out septic arthritis)
Joint x-ray
Blood tests for RF, lipids, glucose
How to treat an acute attack of gout?
rest
full dose NSAID’s
Avoid aspirin as competes for excretion w/ uric acid
What’s 1st line for gout
NSAID’s
Consider lansoprazole
24-48hrs high dose, lower dose 7-10 days
When is Colchicine used for gout
used 2nd line when NSAIDs CI
eg: for CVD, renal disease, GI toxicity
How does colchicine work
Slower onset than NSAIDs
Inhibits neutrophil migration to joint
colchicine dose
0.5mg 2-4x a day until relief/ SE/ total 6mgg taken
Don’t repeat within 3 days
Elderly- 0.5mg every 8hrs
Side effects of colchicine
Nausea and vomiting
Diarrhoea- stop IMMEDIATELY
