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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
3)Drug therapy
4)High alcohol consumption
5)Genetic predisposition


what are the risk factors for decreased uric acid secretion?

1)Increased age
3)hyper tension
4)Drug therapy
6)renal dysfunction


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
-previous history
-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
Agents used:
3)Opioid analgesics
4)Intraarticular/oral corticosteroids


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.


Discuss corticosteroids in terms of treatment of gout

NSAIDs or Colchicine contraindicated or only partially effective
-intra-articular:one or two joints affected, but must differentiate between gout and infective arthritis
-oral: prednisolone
30-40mg daily for 7 days