Gout Flashcards Preview

Core conditions Olivia MD > Gout > Flashcards

Flashcards in Gout Deck (20):
1

what are some factors that predispose hyperuricemia?

age, obesity, hyperlipidemia, Diabetes, hypertension, IHD, family history

2

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

3

how is uric acid excreted?

through the gut and through the kidney

4

what are the two types of crystal arthropathies?

sodium urate and calcium pyrophosphate

5

what receptor is involved in Gout inflammatory attacks

NLRP3

6

what proinflammatory cytokine is associated with gout?

IL8

7

what can cause impaired excretion of uric acid?

Chronic renal disease
Drugs- thiazide/aspirin
HT
Increased lactic acid
Hypothyroidism

8

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

9

what treatment do you give in an acute attack of gout?

NSAIDs like naproxen or colchicine if the patient has renal impairment. Also corticosteroids

10

what is a side effect of colchicine?

diarrhoea

11

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

12

How does allopurinol work?

It blocks the enzyme xanthine oxidase, which converts xanthine into uric acid

13

what is a drug you do not want to use with allopurinol?

azathioprine as it can cause bone marrow suppression

14

How do we commence allopurinol?

with NSAID, titrate up gradually to avoid acute gout attacks

15

what are some side effects of allopurinol?

skin rashes and GIT upset. Also sometimes a severe hypersensitivity reaction can occur

16

other than allopurinol, what other drug can you prescribe?

Febuxostat. It is an analogue inhibitor of xanthine oxidase

17

what can predispose chronic gouty tophi?

chronic diuretic use and renal impairment

18

what is the mechanism of colchicine?

Colchicine works by inhibition of microtubule formation

19

please interpret the following arthrocentesis results:
Volume: > 1m;
Straw colour
WBB elevated
PM Cells = 60%
culture at 0 days = negative
glucose 6.4 mmol/L

non inflammatory?

20

what are the crystal characteristics of pseudogout

short and rhomboid, weakly positively birefringent