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Gout > Gout Pathophysiology > Flashcards

Gout Pathophysiology Flashcards

1
Q

Gout results from deposition of…

A

Monosodium ruate

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2
Q

Monosodium urate is formed from…

A

Uric acid

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3
Q

Monosodium urate often deposits in common areas such as…

A

Synovial fluids
Tissues
Kidney

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4
Q

Uric acid is the end product of…

A

Purine metabolism

No functional role

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5
Q

Overproduction, or under-excretion of uric acid results in…

A

Hyperuricemia

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6
Q

Uric acid can metabolize into…

A

Allantoin

Highly water soluble, excreted easily

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7
Q

Hyperuricemia is a serum acid concentration over…

A

420 micromol/L

Limit of solubility of uric acid

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8
Q

Solubility of uric acid decreases with…

A

Lower temperatures

Why it affects toes often

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9
Q

Precipitation of uric acid may require…

A

A trigger

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10
Q

Some dietary options that contribute to overproduction of uric acid are…

A

Anything rich in purines (meat)

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11
Q

Some disease states that contribute to overproduction of uric acid include…

A

Obesity
Hypertriglyceridemia - more metabolism into uric acid

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12
Q

Some drugs that can cause overproduction of uric acid include…

MOA of causation?

A

Diuretics - fluid leaves from synovial space and increases uric acid in joint
Cytotoxic drugs - increases cell turnover, byproduct = increased uric acid

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13
Q

Some disease states that will cause underexcretion of uric acid include…

A

CKD
Hypertension
Dehydration

Decreased blood flow in kidneys decreases uric acid secretion

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14
Q

Some common drugs that cause underexcretion of uric acid include…

MOA of causation?

A

Alcohol, ACEI/ARB - decrease renal blood flow
ASA - competes for uric acid elimination
Diuretics - decreases how much uric acid is excreted

Others include cyclosporine, levodopa, tacrolimus

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15
Q

On a regular diet, a patient can be labelled an overproducer if excretion of uric acid exceeds…

A

Greater than 1000mg/24 hours

This is only important for MOA of 1 drug

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16
Q

On a regular diet, a patient can be labelled anunder-excretor if excretion of uric acid exceeds…

Assuming high serum uric acid

A

Less than 1000mg/24 hours

This is only important for MOA of 1 drug

17
Q

The four clinical phases of gout include…

A
  1. Asymptomatic hyperuricemia
  2. Acute gouty arthritis
  3. Intercritical gout
  4. Chronic tophaceous gout
18
Q

Asymptomatic hyperuricemia is classified by…

A

Elevated uric acid levels (>420 micromol/L), with no symptoms

Majority DO NOT require drug treatment

Less than 25% actually develop gout

19
Q

Potential consequences of asymptomatic hyperuricemia include…

A

Gout
Urate nepropathy
Nephrolithiasis
CKD

20
Q

We may choose to treat asymptomatic hyperuricemia if the patient has…

A

Kidney impairment
Extreme uric acid levels (>800 micromol/L)

21
Q

Acute gouty arthritis is caused by…

A

Precipitation of uric acid crystals in the joint space

Immune system involvement, causes vasodilation and increased permeability

22
Q

Acute gouty arthritis is characterized by a sudden onset of…

A

Severe pain
Erythema
Limited range of motion
Swelling of the joint

Tends to occur in evening or overnight

23
Q

Acute gouty arthritis often self-resolves in…

A

7-14 days

24
Q

Joints that are most frequently affected by acute gouty arthritis include…

A

Toes>Instep>Ankle>Knee>Wrist>Fingers

25
Q

Possible triggers of an acute gout flare include…

A

Trauma/surgery
Starvation
Fatty food binge
Dehydration
Drugs that impact production/excretion of uric acid

Drugs include urate-lowering therapy which seems counterintuitive, but it happens

26
Q

Intercritical gout is a term to describe…

A

Asymptomatic period between flares

27
Q

The initial intercritical period can last for ____ before recurrence

A

2-10 years

This period becomes shorter as disease progresses

28
Q

The intercritical period is the best time for…

A

Patient education, and implementation of lifestyle changes

29
Q

Chronic tophaceous gout is caused by ____ and can develop…

A

Long-standing, poorly treated gout; can develop at any site, most commonly at feet and hands

30
Q

Tophi are…

A

Uric acid deposits

31
Q

Consequences of chronic tophaceous gout are severe and include…

A

Joint deformity, destruction, and pain
Surrouding tissue damage and nerve compression
Nephrolithiasis, and urate nephropathy

32
Q

General gout complications include…

A

Nephrolithiasis
Urate nephropathy

33
Q

Nephrolithiasis is caused by…

A

Excessive excretion of uric acid; acidic and highly concentrated urine results in precipitation

34
Q

Acute urate nephropathy is when there is…

A

Massive precipitation of uric acid crystals in nephrons

35
Q

Chronic urate nephropathy is when…

A

Microtophi form in the kidneys

36
Q

Diagnosis of gout is primarily made via…

A

Symptoms

37
Q

Baseline lab tests that are good to obtain when diagnosis gout include…

A

CBC’s
Urinarlysis, SCr, BUN - measure kidney health
Serum uric acid levels

Good to investigate comorbidities and risk factors

38
Q

Diagnosis of gout can be confirmed via analysis of…

A

Synovial fluid, under microscope

39
Q

A point system may be used to diagnose gout - criteria includes…

A

Male (2)
Previous similar flare (2)
Rapid onset within one day (0.5)
Joint redness (1)
Toe involved (2.5)
Presence of HTN or CVD (1.5)
High serum urate (3.5)

6+ points = Gout attack

Gout (2 decks)

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