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PM3B: Autumn > Gout and polymyalgia treatment > Flashcards

Gout and polymyalgia treatment Flashcards

1
Q

What is Gout

A

Sodium Urate Crystal Deposition in the joints- needle shaped

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2
Q

What is pseudogout

A

Calcium Pyrophosphate Crystal deposition in the joints

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3
Q

How come gout occurs

A

Abnormality in uric acid metabolism results in deposition of uric acid crystals that cause intermittent attacks of acute joint pain

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4
Q

Where does gout normally occur

A

Big toe

Can result in tophi (white nodules) in skin and around joints

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5
Q

What are the risk factors of gout

A 
Family history
Obesity
Excess alcohol intake
Ketosis
High purine (red meat diet) 
Diuretics
Acute infection
Surgery
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6
Q

What is hyperuricaemia and how is it caused

A

Over production of uric acid, or most commonly, renal under excretion of uric acid

Causes:
Chronic renal disease
Drug therapy- thiazide diuretics, low dose aspirin
Hypertension
Increased lactic acid production (exercise, alcohol, starvation)
Hyperparathyroidism
Hypothyroidism

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7
Q

What does increased production of uric acid lead to

A

Increased purine turnover- myeloproliferative disorders, leukaemia, other cancers, psoriasis

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8
Q

How do you diagnose gout

A

Serum uric acid levels- normally raised

Joint aspirate- taking fluid from joint and looking for crystals

Renal function test- kidney function is adequate

X ray- look at joint erosion

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9
Q

How do you treat acute gout attacks

A

NSAIDS- naproxen
Can use Indomethacin, but doesn’t shown any specific advantage over NSAIDS
DON’T USE ASPIRIN

COLCHICINE
useful for heart failure patients

Corticosteroids
Intra-articular injection (monoarticular gout)
Intramuscular injection

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10
Q

What is the mechanism of action involved with the use of Colchicine in Gout

A

Prevents migration of neutrophils and phagocytes into gouty joints

Binds to tubulin to result in depolymerisation of microtubules and reduced cell motility

Prevents release of inflammatory products by these cells by preventing/limiting phagocytosis of urate crystals

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11
Q

How do you prevent gout lifestyle and taking which drugs away

A

Withdraw thiazides and salicylate

Lifestyle:
Loss weight
Reduce alcohol consumption
Change diet with reduced total calories and cholesterol and avoiding purine rich food (liver, red meat, fish, peas, spinach)

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12
Q

What drugs can you use for prophylaxis (prevention) of gout and when may yours them

A

Frequent recurrent attacks for more than 2 a year or tophi present or signs of chronic gout (joint erosion)

Reduce serum acid levels:
ALLOPURINOL: inhibits uric acid synthesis

URICOSURIC AGENTS: increase uric acid secretion from kidneys (probenecid and sulfinpyrazone)

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13
Q

Explain the mechanism of action behind allopurinol

A

Reduces uric acid synthesis through competitive inhibition of xanthine oxidase

Alloxantlhine (metabolite) also inhibits xanthine oxidase

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14
Q

Explain the mechanism of action behind uricosuric acid agents

A

Increases uric acid secretion by direct action on renal tubule

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15
Q

How is psuedogout caused and what does it affect on the body

A

Calcium pyrophosphate crystals that are deposited into articular cartilage and periarticular tissue

Affects:
Knees, shoulders and wrists

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16
Q

How do you diagnose psudogout

A

Blood tests- raised white blood cell count and normal serum calcium

X ray- calcification of articular cartilage (chrondrocalcinosis)

17
Q

How do you treat pseudogout

A

Rest
joint aspiration with NSAIDs
Local corticosteroids can be useful

May need DMARDS if there’s joint erosion

18
Q

What is juvenile idiopathic arthritis

A

Joint and limb pain that is common in child

19
Q

How do you treat juvenile idiopathic arthritis

A

NSAIDS- relief of pain and stiffness

Children do not need DMARDS
Methotrexate is effective though

Corticosteroids

Biologics:
Abatacept, adalimumab, etanercept

20
Q

What is the clinical syndrome that shows alongside giant cell arteritis

A

Polymyalgia Rheumatica

21
Q

What are the symptoms of Polymyalgia Rheumatica

A

Abrupt stiffness and pain in proximal muscles of shoulder and/or pelvic girdle

Stiffness= worse after rest, malaise, fever, weight loss, anorexia

22
Q

What are the symptoms of giant cell arterita

A

Localised headache, scalp tenderness, facial pain, visual symptoms (double vision, loss of vision)

23
Q

What are the investigations done for giant cell arterita

A

Blood tests- increased erythrocyte sedimentation rate (>30mm/hr) and normocytic anaemia

Temporal artery biopsy

24
Q

How do you treat giant cell arteritis or polymyalgia rheumatia?

A

Treated with cortiocsteorids and response is rapid

PREDNISOLONE

25
Q

What is the mechanism of action of Prednisolone

A

Binds irreversibly to glucocorticoid receptors to prevent them from binding to steroid response elements and modifying gene expression

Modifying gene expression leads to suppression of inflammation

PM3B: Autumn (19 decks)

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