Flashcards in 28. Gout Deck (30)
gout is more common in ( sex)
gout is an ( definition )
acute inflammatory monoarthritis caused by precipitation of monosodium urate crstals in joints
gout is an ... caused by ...
acute inflammatory monoarthritis
precipitation of monosodium urate crystals in joints
gout is associated with
hyperuricemia can be caused by ( name the mechanism and the proportions )
1. underexcretion of uric acid (90%)
2. overproduction of uric acid ( 10%)
hyperuricemia - causes of underexcretion of uric acid
1. idiopathic ( largely )
2. medications ( eg. thiazide diuretics, pyrazinamide )
3. Renal insufficiency
hyperuricemia - causes of overproduction of uric acid
1. Lesch - Nychan syndrome
2. PRPP excess
3. increased cells turnover ( eg. tumor lysis syndrome )
4. Von Gierke syndrome
von Gierke syndrome - deficiency of
Glucose -6 - phosphatase
Gout - crystals
monosodium urate crystals
monosodium urate crystals - characteristics
1. needle shaped
2. (-) birefringent under polarized light
3. blue under perpendicular light
4. yellow under paraller light
gout - presentation of the joint
4. Asymmetric joint distribution
gout clinical presentation and classic manifestation
asymmetric joint distribution swollen, red , painful joint
painful MTP joint of big toe ( podagra )
Tophus formation - area
1. external ear
2. olecreanon bursa ( elbow )
3. Achilles tendon
white, chalky aggregates of uric acid crystals
Acute gout attack tends to occur ...
after meal and alcohol consumption
meal can cause acute gout - mechanism
increased DNA/ RNA
alcohol consumption can cause acute gout - mechanism
alcohol metabolites compete the same exertion sites in kidney as uric acid --> decreased uric acid secretion
acute --> 1.nsaid ( eg. indomethacin ) 2. colchicine 3. glucorticoids
Chronic ( preventive) --> xanthine oxidase inhibitors
treatment of acute gout
1.nsaid ( eg. indomethacin ) 2. colchicine 3. glucorticoids
treatment of chronic gout ( prevention )
xanthine oxidase inhibitors
• Gout occurs from the precipitation of this crystal in joint spaces.
• A 56-year-old man with a history of gout is given a new antihypertensive agent, which causes a gout attack. What drug was likely started?
A thiazide diuretic (blocks excretion of uric acid and increases the likelihood of having a gout flare)
• A patient has swollen, red, painful joints. They appear to be associated with gout. Will they appear in a symmetric or asymmetric pattern?
• Gout crystals are ____ (positively/negatively) birefringent and ____ (needle/rhomboid) shaped, appearing ____ in color under parallel light.
Negatively; needle; yellow (yellow under parallel light)
• Is gout more common in men or women?
• Alcohol use and large meals can exacerbate what joint disease? Why?
Gout; alcohol and other metabolites from the meal compete with uric acid for excretion sites in kidney, causing reduced secretion
• A 55-year-old man who drinks on a daily basis presents with a red, swollen toe. What is the acute management of this patient's disease?
NSAIDs (e.g., indomethacin), glucocorticoids, or colchicine (this patient has gout)
• Name four metabolic diseases/conditions that predispose a patient to gout.
Lesch-Nyhan syndrome, PRPP excess, increased cell turnover (e.g., in tumor lysis syndrome), and von Gierke disease
• Gout is a problem of uric acid buildup. Do the majority of cases involve overproduction or underexcretion?
90% involve underexcretion, and 10% involve overproduction