management of gout Flashcards
define gout/hyperuricemia
Inflammatory response to crystals of monosodium urate monohydrate in joints, renal tubules, and other tissues.
how is gout caused
It is a metabolic disorder characterized by hyperuricemia (normal plasma urate 2–6 mg/ dl). Uric acid, a product of purine metabolism, has low water solubility. When blood levels are high, it precipitates and deposits in joints, kidney and subcutaneous tissue (tophy).
what causes secondary hyperuricemia
occurs in Leukemias, lymphomas, especially when treated with chemotherapy or radiation (due to enhanced nucleic acid metabolism and uric acid production)
can drugs cause hyperuricemia
yes they can,Diuretics (thiazides, furosemide), pyrazinamide, ethambutol, levodopa, aspirin (low dose) reduce uric acid excretion. Niacin, caffeine, alcohol may also lead to hyperuricemia
what causes acute gout attacks
Excessive alcohol consumption
Diet rich in purines
Kidney disease
what would the appearance of the joint that is affected be
Joint- red, swollen and extremely painful: requires immediate treatment.
describe the way gout acts on the joints
Precipitation of urate crystals in the synovial fluid →on being engulfed by the synovial cells, they release mediators → inflammation
Granulocyte migration into the joint; release a glycoprotein which aggravates the inflammation
Increasing lactic acid production from inflammatory cells → local pH is reduced→ more urate crystals are precipitated in the affected joint.
what drugs are given to treat gout that are under the nsaids classification
Naproxen, piroxicam, diclofenac, indomethacin or etoricoxib is given in relatively high and quickly repeated doses.
which drugs are best for producing extremely powerful anti inflammatory response
Naproxen and piroxicam
what is the mechanism in which colchicine acts on gout
Mechanism: inhibits release of chemotactic factors and of the glycoprotein, thus suppressing the subsequent events.
By binding to fibrillar protein tubulin, it inhibits granulocyte migration into the inflamed joint and thus interrupts the vicious cycle.
how long does it normally take colchicine to alleviate gout pain
within 12 hours
what are some side effects of using colchicine
GI- nausea, vomiting, abdominal pain
which patients would require corticosteroids
Used in patients who cannot tolerate NSAIDs, or failed NSAID/colchicine therapy, refractory cases, renal failure, history of peptic ulcer
when would intra-articular administration of corticosteriods be used
when only one or two joints are affected
how can we define chronic gout
Pain and stiffness persist in a joint between gout attacks
