Gout

Question 1

gout

Answer 1

crystal deposits of uric acid in joints –> damage to joints d/t inflm

• not autoimmune
• aka “gouty arthritis”

Question 2

uric acid

Answer 2

nitrogenous waste product usually processed in liver & excreted by kidney

Question 3

primary form (90%)

Answer 3

• almost exclusively in males (95%)
• d/t metb problem (causes elevated uric acid levels)
• familial tendency

Question 4

secondary form

Answer 4

• normal amount of uric acid produced, but accum occurs
• any condition leads to excessive cell turnover
• d/t alcohol abuse

Question 5

why does accum of uric acid occur in secondary form

Answer 5

d/t kidneys not excreting uric acid & continuing to retain it

Question 6

example of “condition” that leads to excessive cell turnover (secondary form)

Answer 6

chemotherapy (Tx for CA) –> uric acid is byproduct of cell breakdown

Question 7

why does alcohol abuse cause secondary form

Answer 7

Purines & pyrimidines are nitrogenous bases joined by hydrogen bonds (A, C, G, T in DNA & U instead of T in RNA)

Question 8

patho

Answer 8

• altered purine metb –> asympt hyperuricemia
• uric acid deposits as crystals in synovial joints –> attempts to remove abn accum by leukocytes –> damage
• PMN leukoytes engulf debris & foreign materials in attempt to remove crystals; however, they are toxic to PMN leukocytes & induce necrosis –> cells die & release their content
• lysosomal Es released from WBCs –> Es damage to cartilage –> exposes subchondral bone –> bone-bone contact –> erosion of bone
• inflm causes non-specific damage

Question 9

stages

Answer 9

1) hyperuricemia (asympt)
2) acute inflm in 1 joint (big toe)
3) acute inflm subsides in approx 1 wk
4) pt asympt for mo-yrs
5) frequent recurrent attacks –> permanent damage

Question 10

stage 2 in gout precipitating events

Answer 10

• hearty meal
• strenuous activity
• alcohol binge
• drugs, etc.

Question 11

stage 2 in gout characteristics

Answer 11

• inflm & swelling
• at night, dec activity causes blood to flow slower & less pressure to periphery –> uric acid diffuses more easily into joint cavity
• greater solubility in blood than in synovial fluid so uric acid crystalizes when it moves into synovium
• temp in distal joints a bit lower than proximal joints, so uric acid crystalizes faster (most common location for gout)

Question 12

Dx

Answer 12

• measure uric acid (serum & urine)

- X-ray

Question 13

Tx for acute attacks

Answer 13

• NSAIDs
• steroids
• colchicine

Question 14

Tx for long-term attacks

Answer 14

• dec hyperuricemia
• inc uric acid excretion
• dec dietary protein
• no alcohol (mostly beer)

Question 15

colchicine

Answer 15

anti-mitotic properties not utilized, drug used for anti-inflm properties and inhibits migration of leukocytes into joints (WBCs engulf uric acid, gets lysed, and reases harmful Es… colchicine blocks this action)