Gout (Exam 3)

Question 1

Gout

Answer 1

Disruption in uric acid metabolism

Deposit of urate salts in certain tissue like joints

Question 2

Gouty Arthritis

Answer 2

Urate crystals in synovial fluid

Acute PAINFUL inflammation

Question 3

Chronic Tophaceous Gout

Answer 3

Advance stage of gout (many years after onset)

Tophi formed

Question 4

Gouty Arthritis: Definition

Answer 4

Recurrent acute arthritis characterized by accumulation of uric acid crystals in one or more joints

Question 5

Gouty Arthritis cause by: (3)

Answer 5

1. Too much uric acid production
2. Too little uric acid excretion in the kidneys (80-90% of time)
3. Increase intake of foods containing purine

Question 6

Types of Gouty Arthritis

Answer 6

Primary = 90%

Secondary (drug induced)

Question 7

Gouty Arthritis : Non Modifiable Risk Factors

Answer 7

-Age

-Gender

-Race

-Ethnicity

Question 8

Gouty Arthritis: Modifiable Risk Factors

Answer 8

-Hyperuricemia

-Obesity

-HTN

-HLD

-Ischemic cardiovascular disease

-CKD

-DM

-Dietary

-Alcohol

-Medications

Question 9

Gouty Arthritis: Manifestations

Answer 9

Pain:
-Intense pain
-Great toe
-Early morning

Inflammation:
-Edema
-Tenderness
-Redness

Fever

Malasia

Question 10

Gouty Arthritis: Pain Manifestation

Answer 10

VERY intense + Sensitive Pain

Great TOE common

Early Morning

Question 11

Gouty Arthritis peaks at ________; can take ________ days to for flare up ti dissipate

Answer 11

24-48 hrs

5-10 days

Question 12

Common Gout Hotspots

Answer 12

Nodules in great toe

Joint of the knee

Question 13

Tophi

Answer 13

Happen with Chronic Gout

Painless nodules filled with uric acid crystals

Question 14

Gouty Arthritis: Obesity and Diet

Answer 14

Increase adiposity / weight gain = Increase gout

Weight loss = Decrease gout incidence

Question 15

Gout: Arthritis Dietary Recommendation

Answer 15

Calorie Restriction

Increase Protein

Decrease Saturated Fat

Replacement of refined complex CHO

Avoid Sugar Sweetened beverages

Protein should come from low-fat dairy products and plant sources of protein, rather than red meat or fish

Question 16

In gout, protein should come from

Answer 16

low-fat dairy products and plant sources of protein, rather than red meat or fish

Question 17

Foods that increase serum urate levels (causing flare)

Answer 17

Fatty meals

Organ-rich foods

Beer

Distilled spirits

Question 18

Following a strict low-purine diet only lowers blood urate levels ______. Thus recent trend is to recommend 1. 2. 3.

Answer 18

15-20%

1. Losing weight
2. Taking medication
3. Eating as recommended

Question 19

How do we diagnose gout?

Answer 19

Serum uric acid (elevated)

24 hr urine for urine auric acid (is the disease from decreased renal secretion or overproduction)

Synovial fluid

Question 20

Gout Diagnostics: Serum uric acid

Answer 20

Elevated

Question 21

Gout Diagnostics: 24 hr urine for urine uric acid

Answer 21

Helps determine if disease caused by decreased renal excretion or overproduction of uric acid

Question 22

Gout Diagnostics: Synovial Fluid

Answer 22

Typically not aspirated (80% can be dx without) but is GOLD standard

Contain needle like crystals of sodium urate

Question 23

Gout Arthritis: Nursing Problems

Answer 23

Acute Pain

Impaired physical mobility

Altered nutrition: more than body requirements

Deficient knowledge

Question 24

Gouty Arthritis: Collaborative Care

Answer 24

Weight reduction and other modifiable risk factors

Pain control and joint immobilization during flare up

Encourage fluids to maintain increase urine volume to prevent precipitation of uric acid in renal tubules

Question 25

What is the primary therapy of acute and chronic gout?

Answer 25

Drug therapy

Question 26

Acute Gout: Drug Therapy

Answer 26

Colchicine + NSAIDS Dramatic Relief within 12-24 hrs

Question 27

Prophylactic drug therapy for gout

Answer 27

Allopurinol 2-6 week time to improvement