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Inflammatory & GI Diseases > Gout > Flashcards

Gout Flashcards

1
Q

What is gout?

A

Hyperuricaemia. Deposition of monossodium urate monohydrate in joints & self tissue -> acute inflammation & eventually tissue dmg

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2
Q

What is primary gout?

A

Due to rare inborn errors of metabolism or renal excretion

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3
Q

What is secondary gout?

A

Occur due to drugs / consequence of other disorders.

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4
Q

What is the pathophysiology of gout?

A

Physiological pH -> uric acid is ionised -> monosodium urate.
If supersaturation occurs -> crystal formation.
Crystal depositoin may continue for many years wihtout causing symptoms.
Only causes problems when it sheds into the blood into small sacs of synocial fluid -> inflammation

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5
Q

What are the 5 stages of clincal presentation of gout?

A

Asympotmatic hyperuricaemia
Acute gouty arthritis
Interval gout /Intercritical gout
Chronic tophaceous gout.
Gouty nephropthy

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6
Q

What is Acute gouty arthritis?

A

Caused by deposition of urate crystals in joints.
Severe pain with hot, red, swollen & extremely paindul joints.
Begin abruptly - max pain 8-12 hrs.

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7
Q

What is intercritical gout?

A

Time between acute attacks of gout. Variable intervals of months - yrs where there are no symptoms

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8
Q

What is chornic Tophaceous gout?

A

Presence of tophi:
White deposites of monosodium urate.
Nodule formation affecting joints.

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9
Q

What is gouty nephropathy?

A

Crystals of gout deposited around renal tubules -> inflammatory response.
Renal stone formation.

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10
Q

How do you diagnose gout?

A

Based on clicnical histroy & examination
Uric acid lvls can be useful but not always raised when someone has an acute attack.
Joit fluid microscopy - Presense of crystals & absence of infection.

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11
Q

What is the aim for the treatment of gout?

A

Releive pain / inflammation of acute attack.
Terminate attack.
Prevent further attacks
Prevent long term joint & organ dmg

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12
Q

During an acute attack of gout what would the first line treatment be?

A

NSAIDs:
Releive pain & Inflammation
Can abort an acute attack if taken early enough
Full therapeutic range - High dose for 24-48hrs then lower doses for 7-10 days.
Consider PPI

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13
Q

During an acute attack of gout what would the second line treatment be?

A

Colchicine:
Slower onset - High lvls of toxicity.
–| neutrophil migration into joints.
Administer ASAP -> less effective over time.

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14
Q

What is the does of Colchicine in an acute attack?

A

O.5mg 2-4 / Day until releif of joint pain / development of GI s/e total of 6mg / Day
Do not repeat course within 3 Days
Lower dose of 0.5mg / 8 hrs in elerdly/renal impairment.

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15
Q

What are the S/E of colchicine?

A

Nausea & Vominiting.
Abdominial pain
Diarrhoea -> stop therapy immediatley.

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16
Q

What dose of CC would you give in acute gout?

A

Prenisolone 30-35mg daily
- Pred 35mg for 5 days as effective as naproxen 500mg BD for 5 days for flare treatment.
- Pred 30mg daily for 5 days has analgesic effectiveness equivalent to indomethicin.

17
Q

When should prophylaxis of gout be considered?

A

Consider when PtT have 2 or more attaks per yr, tophi, chronic gouty arthritis, joint dmg, renal impairment.

18
Q

What do Urate Lowering Therapy (ULT) do?

A

Decreases frequency of flare up
Once crystals have dissolved prevents reoccurence.
Reduce size of tophi & number of tophi.

19
Q

What is the first line prophylaxis of gout ?

A

Allopurinol:
Controls symptoms
Some imporvement in tophi
Xanthin odixase –|
Colchicine:
First 6 months
0.5-1mg daily to prevent flare ups and to reach target range.

20
Q

What dose of allopurinol be given for the prophylaxis of gout?

A

Start at 100mg daily.
Increase every 3-4 weeks accordinly to response to acheive decrease serum urate lvls.
Usual maintanance dose is 300mg daily (100-600mg)
Drug accumulates in renal impairment (50-100mg daily)

21
Q

What are teh S/E of allopurinol?

A

Rashes
Hypersensitivity reactions
GI disturbances.

22
Q

What is an alternative to allopurinol for the prophylaxis of gout?

A

Febuxostat:
Alternaitve to allopurinol if C/I or intolerant.

23
Q

What is the dose of febuxostat?

A

80mg OD (Increase to 120mg if uric acid lvls >357nmol/L after 2-4 weeks)

24
Q

What are the S/E of febuxostat?

A

GI
Headache
Increased LFG
Oedema
Rash

25
Q

What is the second line treatment for prophylaxis of gout?

A

Uricosuric Agents: Sulfinpyrazone, probenacid
Avoid urate nephropathy
Ineffective in poor renal function
Need to maintain high fluid intake to reduce risk of store function.

26
Q

Interactions of Allopurinol and azathioprin?

A

Azathioprine metabolised into mercaptopurine.
Mercaptopurine metabolised by xanthine oxidase
Allopurinol causes accumulation -> fatal bone marrow suppression.

Inflammatory & GI Diseases (14 decks)

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