Gout Flashcards
(35 cards)
What is gout?
inflammatory arthritis caused by deposition of monosodium urate crystal s in synovial fluid (most common form of inflammatory arthritis)
Hyperuricemia is defined by…
serum urate level >7 mg/dL (males)
serum urate level >6 mg/dL (females)
gout is more prominent in men than women with the exceptions of…
post-menopausal women
Which enzyme do humans lack?
uricase
Acute gouty arthritis
- monoarticular
- typically effect first MTP joint –> podagra
gouty nephropathy
- nephrolithiasis (kidney stones)
- acute on chronic renal impairment
Tophi (or Tophaceous gout)
MSu crystal deposits within the synovial fluid
Predisposing Factors
- dietary
- medications
- medical conditions
- other
Dietary Factors
- meat and seafood (increase purine)
- fatty foods
- dietary overindulgence
- alcohol
- sugar-sweetened soft drinks
- high-fructose foods
Medication Factors
- aspirin (ASA)/salicylates
- Calcineurin inhibitors (cyclosporine, tacrolimus)
- Cytotoxic chemotherapy (i.e. paclitaxel)
- Diuretics (loops, thiazides)
- Nicotine acid (niacin)
- Pyrazinamide
- Teripatide
- Testosterone
medical conditions
obesity; renal transplant; metabolic syndrome
diabetes; hypertension; dyslipidemia; CHF; renal insufficiency; early menopause; psoriasis; hypothyroidism; sarcoidosis; hyper/hypo-parathyroidism; myeloproliferative disorders; anemias
Other conditions
- starvation
- dehydration
- lead toxicity
- acute or episodic alcoholism
- enzyme deficiencies (HGPRT & PRPP)
Gout classifications:
MILD
one joint, stable disease
Gout classifications:
MODERATE
2 or 4 joints, stable disease
Gout classifications:
SEVERE
- 4 or more joints, stable disease
- unstable, complicated, severe articular top
non-pharm treatment
- limit purine rich foods, alcohol intake, high-fructose corn syrup & maintain adequate hydration
- promote weight loss
- adjuvant ice therapy (avoid heat -may worsen attacks)
Pharm treatment goals
- terminate acute attacks
- prevent recurrent attacks of gouty arthritis
- prevent complications assoc. w/ disposition of urate crystals in tissues
- prevent/reverse comorbidities assoc. w/ your (i.e. obesity, hypertension)
Acute gout treatment
NSAIDs, Corticosteroids, Colchicine
NSAIDs
- Indomethacin (indocin), Naproxen (Naprosyn), Sulindac (Clinoril), Celecoxib (Celebrex)
- Initiate 24-48 hours
- Consider if GI AE effects limit use of other NSAIDs
- AVOID: if significant CAD hx
- Consider PPI therapy for longer NSAID course if risk of GI bleed
NSAID contraindications
- active PUD
- decompensated heart failure
- severe renal impairment (CrCl less than or equal to 30 mL/min
- hypersensitivity to ASA/NSAIDs
Corticosteroids
- Prednisone
- Methylprednisolone (Solumedrol, Medal)
- Triamcinolone (Kenalog)
- Adrenocorticotropin Hormone (ACTH)
Corticosteroids time of initiation
24-48 hours
Corticosteroids AE
metabolic SE
—- HTN
—- Hyperglycemia
Corticosteroids CI
- avoid IA injection if septic arthritis can’t be r/o
- severe/uncontrolled hyperglycemia
- active systemic infections
