Gout and polymyalgia treatment Flashcards Preview

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Flashcards in Gout and polymyalgia treatment Deck (25):
1

What is Gout

Sodium Urate Crystal Deposition in the joints- needle shaped

2

What is pseudogout

Calcium Pyrophosphate Crystal deposition in the joints

3

How come gout occurs

Abnormality in uric acid metabolism results in deposition of uric acid crystals that cause intermittent attacks of acute joint pain

4

Where does gout normally occur

Big toe

Can result in tophi (white nodules) in skin and around joints

5

What are the risk factors of gout

Family history
Obesity
Excess alcohol intake
Ketosis
High purine (red meat diet)
Diuretics
Acute infection
Surgery

6

What is hyperuricaemia and how is it caused

Over production of uric acid, or most commonly, renal under excretion of uric acid

Causes:
Chronic renal disease
Drug therapy- thiazide diuretics, low dose aspirin
Hypertension
Increased lactic acid production (exercise, alcohol, starvation)
Hyperparathyroidism
Hypothyroidism

7

What does increased production of uric acid lead to

Increased purine turnover- myeloproliferative disorders, leukaemia, other cancers, psoriasis

8

How do you diagnose gout

Serum uric acid levels- normally raised

Joint aspirate- taking fluid from joint and looking for crystals

Renal function test- kidney function is adequate

X ray- look at joint erosion

9

How do you treat acute gout attacks

NSAIDS- naproxen
Can use Indomethacin, but doesn't shown any specific advantage over NSAIDS
DON'T USE ASPIRIN

COLCHICINE
useful for heart failure patients

Corticosteroids
Intra-articular injection (monoarticular gout)
Intramuscular injection

10

What is the mechanism of action involved with the use of Colchicine in Gout

Prevents migration of neutrophils and phagocytes into gouty joints

Binds to tubulin to result in depolymerisation of microtubules and reduced cell motility

Prevents release of inflammatory products by these cells by preventing/limiting phagocytosis of urate crystals

11

How do you prevent gout lifestyle and taking which drugs away

Withdraw thiazides and salicylate

Lifestyle:
Loss weight
Reduce alcohol consumption
Change diet with reduced total calories and cholesterol and avoiding purine rich food (liver, red meat, fish, peas, spinach)

12

What drugs can you use for prophylaxis (prevention) of gout and when may yours them

Frequent recurrent attacks for more than 2 a year or tophi present or signs of chronic gout (joint erosion)

Reduce serum acid levels:
ALLOPURINOL: inhibits uric acid synthesis

URICOSURIC AGENTS: increase uric acid secretion from kidneys (probenecid and sulfinpyrazone)

13

Explain the mechanism of action behind allopurinol

Reduces uric acid synthesis through competitive inhibition of xanthine oxidase

Alloxantlhine (metabolite) also inhibits xanthine oxidase

14

Explain the mechanism of action behind uricosuric acid agents

Increases uric acid secretion by direct action on renal tubule

15

How is psuedogout caused and what does it affect on the body

Calcium pyrophosphate crystals that are deposited into articular cartilage and periarticular tissue

Affects:
Knees, shoulders and wrists

16

How do you diagnose psudogout

Blood tests- raised white blood cell count and normal serum calcium

X ray- calcification of articular cartilage (chrondrocalcinosis)

17

How do you treat pseudogout

Rest
joint aspiration with NSAIDs
Local corticosteroids can be useful

May need DMARDS if there's joint erosion

18

What is juvenile idiopathic arthritis

Joint and limb pain that is common in child

19

How do you treat juvenile idiopathic arthritis

NSAIDS- relief of pain and stiffness

Children do not need DMARDS
Methotrexate is effective though

Corticosteroids

Biologics:
Abatacept, adalimumab, etanercept

20

What is the clinical syndrome that shows alongside giant cell arteritis

Polymyalgia Rheumatica

21

What are the symptoms of Polymyalgia Rheumatica

Abrupt stiffness and pain in proximal muscles of shoulder and/or pelvic girdle

Stiffness= worse after rest, malaise, fever, weight loss, anorexia

22

What are the symptoms of giant cell arterita

Localised headache, scalp tenderness, facial pain, visual symptoms (double vision, loss of vision)

23

What are the investigations done for giant cell arterita

Blood tests- increased erythrocyte sedimentation rate (>30mm/hr) and normocytic anaemia

Temporal artery biopsy

24

How do you treat giant cell arteritis or polymyalgia rheumatia?

Treated with cortiocsteorids and response is rapid

PREDNISOLONE

25

What is the mechanism of action of Prednisolone

Binds irreversibly to glucocorticoid receptors to prevent them from binding to steroid response elements and modifying gene expression

Modifying gene expression leads to suppression of inflammation