Flashcards in Gout Deck (20):
what are some factors that predispose hyperuricemia?
age, obesity, hyperlipidemia, Diabetes, hypertension, IHD, family history
what is the role of xanthine oxidase?
The last two steps of purine metabolism in humans are the conversion of hypoxanthine to xanthine and of xanthine to uric acid, catalysed by the enzyme xanthine oxidase
how is uric acid excreted?
through the gut and through the kidney
what are the two types of crystal arthropathies?
sodium urate and calcium pyrophosphate
what receptor is involved in Gout inflammatory attacks
what proinflammatory cytokine is associated with gout?
what can cause impaired excretion of uric acid?
Chronic renal disease
Increased lactic acid
what can cause increased production of uric acid?
onditions that cause high cell turnover
E.g. haematological malignancy
Hypoxanthine-guanine-phosphoribosyl transferase (HGPRT) reduction (an X-linked inborn error causing the Lesch–Nyhan syndrome)--> causes increased purine synthesis
what treatment do you give in an acute attack of gout?
NSAIDs like naproxen or colchicine if the patient has renal impairment. Also corticosteroids
what is a side effect of colchicine?
what is the treatment aim for using drugs to reduce hyperuricemia?
The aim of treatment is to reduce the uric acid level below the 360 µmol/L level; some guidelines recommend below 300 µmol/L
How does allopurinol work?
It blocks the enzyme xanthine oxidase, which converts xanthine into uric acid
what is a drug you do not want to use with allopurinol?
azathioprine as it can cause bone marrow suppression
How do we commence allopurinol?
with NSAID, titrate up gradually to avoid acute gout attacks
what are some side effects of allopurinol?
skin rashes and GIT upset. Also sometimes a severe hypersensitivity reaction can occur
other than allopurinol, what other drug can you prescribe?
Febuxostat. It is an analogue inhibitor of xanthine oxidase
what can predispose chronic gouty tophi?
chronic diuretic use and renal impairment
what is the mechanism of colchicine?
Colchicine works by inhibition of microtubule formation
please interpret the following arthrocentesis results:
Volume: > 1m;
PM Cells = 60%
culture at 0 days = negative
glucose 6.4 mmol/L