Gout

Question 1

this is a classic example of crystal-induced inflammation of synovial joints. disturbance of uric acid metabolism and excretion leads to deposition on monosodium urate salts in articular, periarticular and subcutaneous tissue

Answer 1

gout

Question 2

true or false: gout is more common in women

Answer 2

false - three times more common in men

Question 3

true or false: gout episodes tend to resolve completely and spontaneously

Answer 3

true - but if not treated can cause deformity

Question 4

true or false: impaired renal function is related to the occurrence of gout

Answer 4

true - decreased glomerular filtration rate = decreased uric acid excretion

Question 5

this shows no clinical signs but serum urate levels are elevated. can begin at puberty in males, but in female usually does not appear before menopause. no treatment is needed here

Answer 5

asymptomatic hyperuricemia

Question 6

is gout more commonly caused by over-production of uric acid or under-excretion of uric acid

Answer 6

under-excretion is the cause of most cases (90%)

Question 7

this may be caused by diseases causing increased cell turnover (psoriasis) or disease with high DNA breakdown (cancer Tx)

Answer 7

gout

Question 8

does this describe over-production or under-excretion of uric acid
- primary defect in the metabolism of purines (hypoxanthine guanine phosphoribosyl transferase deficiency)
- diseases causing increased cell turnover (chronic myeloid leukemia, tx of neoplasia)

Answer 8

over-production

Question 9

does this describe over-production or under-excretion of uric acid
- decreased glomerular filtration
- diuretic side effects

Answer 9

under-excretion

Question 10

although the concentration of monosodium urate in joint fluid slowly equilibrates with that in the serum, crystal formation is influenced by physical factors such as ______ and ________

Answer 10

temperature and blood flow (which is why gout occurs in distal joints such as big toe and ankles, because they are more colder and proximal to other joints)

Question 11

monosodium urate crystals have highly ________ charged surfaces which imitates the acute inflammatory response

Answer 11

negatively

Question 12

monosodium urate crystals active the __________ pathway generating cleavage products (such as C3a and C5a) that are strong chemoattractants for neutrophil influx

Answer 12

complement

Question 13

monosodium urate crystals activate the _____ system and in that way induce local vasodilation, pain and swelling

Answer 13

kinin

Question 14

what are some pro-inflammatory cytokines involved with gout, that increase adhesion molecule expression on local vessel endothelium to facilitate neutrophil adhesion and migration and are also potent chemoattractants for neutrophils

Answer 14

IL-1beta, TNF-alpha, IL-8 and PGE2)

Question 15

neutrophils amplify their own recruitment by releasing ________ upon urate crystal phagocytosis

Answer 15

leukotriene LTB4

Question 16

the intense inflammatory response in gout typically resolves spontaneously. what are some down regulation mechanisms

Answer 16

• efficient phagocytosis of the crystals (removal of stimulus)
• increased heat and fluid influx (helps dissolve the crystals)
• coating of the crystals with serum proteins (thus the surface of the crystal is less inflammatory)
• secretion of anti-inflammatory cytokines (e.g. TNF-beta) by activated joint macrophages
• phagocytosis of previously activated apoptotic neutrophils by macrophages in the joint

Question 17

this severe inflammatory arthritis at the first metatarsophalangeal joint, is the most frequent manifestation of gout

Answer 17

Podagra

Question 18

clinical manifestations of this type of gout include
- most common early clinical sign
- weight bearing joints most commonly affected: warm, red, swelling and extreme pain tender to palpitation
- Podagra, but ankles and knees also affected
- initial attacks can last 1-14 dayy

Answer 18

acute gouty arthritis

Question 19

this is a term used to describe the intervals between acute attacks. there are no symptoms present but urate crystals can still be aspirated from involved joints

Answer 19

inter-critical gout