Flashcards in Gout Deck (15):
when does a Gout attack usually first occur
50-60 years in men
post menopausal women
what is GOUT?
an acute inflammatory arthritis induced by the deposiition of uric acid crystals in the joints (xanthine oxidase) with precipitating factors.
how does GOUT occur
Gout occurs due to increased uric acid production and decreased uric acid excretion
What are the classifications of GOUT?
1)primary GOUT (90-95%): results from inborn errors of metabolism causing overproduction of uric acid, idiopathic
2)secondary GOUT (5-10%): results from increased production or decreased excretion of uric acid
what are the risk factors of increased uric acid production?
2)Increased tissue turnover
4)High alcohol consumption
what are the risk factors for decreased uric acid secretion?
what is the clinical term for gout of the foot
describe the clinical presentation of an acute gout attack?
-joints affected: foot,ankle,knees,fingers,elbows,
acute attack consists of:
1)hot,excruciatingly painful joint
2)Red and dry skin
3)Crystals in synovial fluid
4)raised white cell count
5)low grade fever
How is a diagnosis of GOUT clarified?
-demonstration of uric acid crystals in the synovial fluid from joint
-elevated serum urate concentration
-Evidence of good response to drug treatment
Explain what is Chronic Gout?
occurs after years of GOUT attacks, bone and cartilage destruction leads to deformity. uric acid crystals deposit within and surrounding the joint, tophi- deposits of uric acid crystals. this is a chronic destructive inflammatory process.
describe key goal of acute gout attack treatment and treatment methods?
Key goal- prompt and effective pain management
discuss NSAIDs in terms of treatment of GOUT
Treatment of choice
Indometacin often quoted as agent of choice: 50mgs tds or qid until significant improvement and then dose is tailored
onset of action:
24-48 hours with complete relief of symptoms within 5 days.
Discuss Colchicine in terms of treatment of gout
often used when NSAIDs are contraindicated
Colchicine depresses leukocyte multiplication and movement and release of inflammatory mediators.
Dose: 500mcg 2-4 times daily until: relief of pain, GI side effects occur or total of 6mg reached (no more than 3 DAYS)
GI side effects occur in 80% patients
Discuss opioid analgesics in terms of treatment of gout
NSAIDs: not effective for 24 hours
Colchicine: not effective for 6-12 hours
Patient will require additional analgesia until these agents take effect
opioids provide immediate pain relief: paracetamol,simple analgesics.