MED: Gout

Question 1

What generally metabolized purines throughout the body?

Answer 1

Xanthine Oxidase

Question 2

What’s the product of purine metabolism?

Answer 2

Uric acid (urate)

Question 3

What transporter is responsible for uric acid (urate) reabsorption?

Answer 3

URAT1

Question 4

How does uric acid preciptate?

Answer 4

Sharp needle-like crystals

Question 5

Is hyperuricemia alone sufficient to produce a gout attack? If not, what else is req?

Answer 5

No

Temp (cooler), pH (lower/acidic, d/t trauma), joint hydration (nocturnal dehydration

Question 6

How does one accumulate too much uric acid (urate)?

Answer 6

Too much uric acid production (diet, tumor lysis syndrome)

Excreting too little d/t: gene defect in URAT1, drugs (diuretics, low-dose ASA), poor kidney function

Question 7

What’s the paradox of ULT (urate lowering tx) in gout? What might this lead to? How can this all be avoided?

Answer 7

In early phases can cause an inc in acute gout attacks (though they may not be symptomatic)

Medication non-compliance

Include an NSAID or Colchicine during initial tx phase to limit acute gout

Question 8

What genetic predisposition can cause a hypersensitivity reaction while taking Allopurinol?

Answer 8

HLA-B*5801

Question 9

Do thiazide diuretics affect gout tx? If so, how?

Answer 9

Yes

Affects multiple transporters in the proximal tubule causing uric acid retention > drug associated gout