MSK 09

Question 1

What is Gout?

Answer 1

Caused by deposition of uric acid crystals in joint species and surrounding tissue
An acute attack lasts for 7-10 days but it is a chronic disease. if not treated damages kidney and joints

Question 2

Which cites are most prone of Gout attack?

Answer 2

Metatarsophalangeal joint most common

Ankle knee and elbow

Question 3

What are the causes of developing Goat?

Answer 3

Uric acid produce in our body naturally and they are the waste product of our purine breakdown which excreted by the kidney but why they cannot excreted or reabsorbed by (proximal tubule)then they cause increase of uric acid in our blood which cause hyperuricemia or Gout.

Question 4

What is the parameter when we call hyperuricaemia?

Answer 4

> 0.36 mmol/L in women

>0.42 mmol/L in Men

Question 5

How you diagnose Gout?

Answer 5

If Serum uric level is higher than 0.36mmol/L patient will experience red pain and inflammation.

Question 6

Uric acid balance depends on which factors?

Answer 6

Diet: Red meat, fish Alcohol, bear they increase uric acid
Ethnicity: Maori Man around 12 % prone to gout.

Question 7

Q: Acute gout attack occurs when?

Answer 7

MSU crystal comes in particular joint space
Release of pro inflammatory mediator’s TNF and IL-1 IL-8
Phagocytosis of MSU crystal by neutrophils

Question 8

Gout is characterized by?

Answer 8

Severe pain and inflammation

Question 9

What are the side effects of NSAIDs?

Answer 9

(Formula GIMIRI)
GI bleeding
MI Myocardial infection
RI Renal impairment

Question 10

Q: Gout is usually a mono or poly articular disease?

Answer 10

Mono articular disease

because we have seen that this disease 90% occur in Metatarsophalangeal joint.

Question 11

Side effects of Colchicine?

Answer 11

Its Therapeutic index is very narrow
Colchicine early toxicity is, GI toxicity like Nausea, vomiting, pain, diarrhoea.
Cardiac damage, corneal ulcer, Vit B12 absorption decreases

Question 12

Colchicine drug interaction?

Answer 12

This drug is metabolised by CYP450 & 3A4 & P-gp
They interact with azole, statin, Macrolides grapefruits as a result the level of colchicine will increase in the blood serum and will cause toxicity. Refer to hospital immediately.

Question 13

Colchicine can be toxic with camotherapeutic agent it gives?

Answer 13

Additive effects on cell division

Question 14

What is the mechanism of Glucocoticosteroids?

Answer 14

It decreases arachidonic acid formation by inhibiting Phospholipase A2 resulting decreased prostaglandin synthesis. Decrease transcription of pro-inflammatory genes result decreased production of cytokines reduces inflammation

Question 15

Side effects of Glucocorticoids?

Answer 15

Osteoporosis may develop with long term use of glucocorticoids.
Cardiovascular risk
GI bleeding
Infection

Question 16

What is the Long-term prevention of GOUT or urate lowering therapy?

Answer 16

1. Xantine-Oxidase inhibitors i.e.: allopurinol, Febuxostat

2. Uricosurics i.e. probenecid

Question 17

The primary site of reabsorption of uric acid in our kidney is?

Answer 17

URAT1 if we block this than uric acid reabsorption will decrease, and excretion will increase.

Question 18

Which criteria will make a patient to take urate lowering therapy?

Answer 18

If it causes more than 2 gout attacks in a year.
Chronic kidney disease
If Tophi appears (Deposition of uric crystal)
Urolithiasis (kidney stone)

Question 19

What is your target Uric acid level in blood if you start ULT?

Answer 19

So, when we start ULT therapy our target serum uric acid level is Less than 0.36 mmol/L when tophi are present.

Question 20

What is Allopurinol?

Answer 20

Xanthine oxidase inhibitor

Start with a low dose as it might leads to Allopurinol hypersensitivity syndrome

Question 21

To check Allopurinol hypersensitivity syndrome a test is required that is?

Answer 21

HLA-B 5801

Question 22

What is Allopurinol hypersensitivity syndrome?

Answer 22

It is called DRESS =Drug Rash Eosinophilia and Systemic Symptoms
So, the symptoms are: Rash, Fever, Eosinophilia etc
Around 25% who develop DRESS die
DRESS may start withing 2-6 weeks after taking allopurinol so strict monitoring is required for this treatment.
So, allopurinol treatment is not recommended for Asymptomatic GOUT until it reaches last stage of the crystallisation.

Question 23

What is Febuxostat?

Answer 23

Second line xanthine oxidase inhibitor

Question 24

What are the side effects of Febuxostat?

Answer 24

Serious hypersensitivity reaction
Stevens Johnson syndrome
Cardiovascular effects

Question 25

What are the Uricosuric (URTA1 blocking) Drugs?

Answer 25

1.Probenecid
2.Benzbromarone
3.Sulfinpyrazone
4.Lesinurad
These drugs act on URAT1 transporter by preventing Reabsorption of Uric acid from kidney as a result ultimately uric acid excrete by urine.

Question 26

What is the first choice among uricosuric (URAT1 blocking) agent is ?

Answer 26

Probenecid

Question 27

What is the major Drug Drug interaction of Allopurinol?

Answer 27

It interacts with Azathioprine & mercaptopurine
Because Allopurinol and febuxostat inhibit Zanthine oxidase which one of the metabolite enzyme of mercaptopurine 6 so if we inhibit xanthine oxidase the level of mercaptopurine 6 level in our blood goes up and result Bone marrow toxicity.

Question 28

What is Benzbromarone?

Answer 28

Renal tubular blocking agent (URAT1 blocker)
But it has hepatic toxicity
Introduced in 2018 but not available in market yet