Lecture 18 Gout

Question 1

Gout is a (inflammtory/non-inflammatory) arthritis that is triggered by the crystallization of ____ in joints. Due to defect in ____ in humans

Answer 1

inflammatory; Uric acid; uricase

Question 2

What dietary factors are associated with gout, and why do they predispose one to gout?

Answer 2

meat and seafood; have high levels of purine

Question 3

In the majority of patients, gout results from salvaged _____ as a result of increased ____ _____

Answer 3

purine, cell turnover

Question 4

Why does alcohol cause gout attacks?

Answer 4

compete for same excretion sites in kidney as uric acid (according to FA)

Question 5

decreased ____ excretion can lead to uric acid accumulation.

Answer 5

renal

Question 6

Presence of ______ crystals within synovial fluid; excess crystals show as ____. There is a large amount of _____ influx in the synovium

Answer 6

monosodium;
nodules;
neutrophillic

Question 7

Mechanism of interaction between urate crystals and phagocytes:

1. opsonization/phagocytosis causes a release of ____ ____
2. interaction directly with lipid membrane, causing cell membrane ____

Answer 7

inflammatory mediators

pertubation

Question 8

classic presentation at onset:

Answer 8

very acute onset, mono-articular, highly inflammatory arthritis (Redness and pain of joint)

Question 9

what is a podagra?

Answer 9

inflammation of metatarselphalangeal (MTP) joint

Question 10

polyarticular gout is more likely to occur after the _____ _____

Answer 10

initial manifestation

Question 11

what is a tophus, and where do they occur?

Answer 11

chalky aggregates of urate surrounded by fibrosis;

ear, olcrenanon bursa, tendons (esp achilles)

Question 12

____ cysts are seen on x-ray, often described as “___ ___ lesions”

Answer 12

subcortical; rat bit

Question 13

acute flares are controlled by ____, ____, or ____ (if started within 36 hours)

Answer 13

NSAIDS, cortiocsteroids, colchicine

Question 14

____ or ____ can be used as low dose prophylaxis

Answer 14

NSAIDS, colchicine

Question 15

Allopurinal and febuxostat are ____ ____ inhibitors, used to treat chronic gout

Answer 15

xanthine oxidase

Question 16

_____ causes an increase uric acid secretion. _____ is a pegylated uric acid specific enzyme.

Answer 16

Probenecid; pegloticase

Question 17

target uric acid concentration to lower to:

Answer 17

less than 6 mg/dL

Question 18

most important complication of gout

Answer 18

renal complications (ie kidney stone or nephropathy)