Gout

Question 1

What is gout?

Answer 1

it is a type of arthritis where crystals of uric acid are deposited into joints

Question 2

What are the two forms of gout? Which is more prevalent?

Answer 2

primary and secondary - primary makes up 90% of gout

Question 3

Who is affected most by primary gout?

Answer 3

95% of cases occur in men

Question 4

What causes primary gout?

Answer 4

metabolic problem

Question 5

What causes secondary gout?

Answer 5

• cell destruction (tumours, leukemia) - because breakdown product of purines (adenine and guanine) is uric acid
• renal problems (unable to excrete uric acid)
• others ex. chemotherapy, beer

Question 6

What is the pathology of gout?

Answer 6

• altered purine metabolism leads to asymptomatic hyperuricemia
• later: crystals deposit in synovial joints
• WBC influx and complement activation
• WBC phagocytize the crystals > WBCs die > the WBCs release their contents, which happen to be enzymes that lead to inflammatory joint damage
• recurrent acute attacks lead to lesions called tophi (these are accumulations of uric acid crystals)

Question 7

What are the manifestations of gout? List as stages.

Answer 7

1) asymptomatic hyperuricemia
2) acute inflammation - usually overnight, occurring in big toe, may be after certain foods, drugs, alcohol or excessive exercise
3) usually subsides after 1 week
4) can be asymptomatic for months-years
5) frequent recurrent attacks, affecting more than one joint, leads to permanent damage

Question 8

How is gout diagnosed?

Answer 8

• serum and urine uric acid

- uric acid in joints (x-ray)

Question 9

How is an acute attack of gout treated?

Answer 9

- NSAID
or
- colchicine (limits migration of WBCs into joint but only use it short term because it is an anti-mitotic)
or
steroids

Question 10

How are gout attacks prevented?

Answer 10

• decrease hyperuricemia
• increase uric acid excretion
• no alcohol
• decrease protein in the diet?