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im immuno/rheuma > Gout_Arthropathies > Flashcards

Gout_Arthropathies Flashcards

1
Q
  • metabolic disease that most often affects middle-aged to elderly men and postmenopausal women
  • results from an increased body pool of urate with
    hyperuricemia
  • Characterized by episodic acute arthritis or chronic
    arthritis caused by deposition of MSU crystals in joints and connective tissue tophi and the risk for deposition in kidney interstitium or uric acid nephrolithiasis
A

Gout

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2
Q
  • most common early clinical manifestation of gout
  • only one joint is affected initially, but polyarticular acute gout can occur in subsequent episodes
  • The metatarsophalangeal joint of the first toe often is involved, but tarsal joints, ankles, and knees also are affected commonly
A

Acute arthritis

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3
Q

first manifestation of gouty arthritis

A

inflamed Heberden’s or Bouchard’s nodes

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4
Q

first episode of acute gouty arthritis frequently begins at ___with dramatic joint pain and swelling

A

night

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5
Q

Joints in arthritis rapidly become ___, with a clinical appearance that often mimics that of cellulitis

A
  • warm,
  • red, and
  • tender
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6
Q

Early attacks of arthritis tend to subside
spontaneously within

A

3-10 days

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7
Q

Several events may precipitate acute gouty arthritis:

A
  • dietary excess
  • Trauma
  • Surgery
  • excessive ethanol ingestion
  • hypouricemic therapy
  • serious medical illnesses:
    + myocardial infarction
    + stroke
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8
Q

A proportion of gouty patients may present with a chronic nonsymmetric synovitis, causing

A

potential confusion with rheumatoid arthritis

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9
Q

Women represent only 5—20% of all patients with gout

A
  • postmenopausal and elderly
  • have osteoarthritis
  • arterial hypertension that causes mild renal
    insufficiency, with diuretics
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10
Q

presumptive diagnosis ideally should be confirmed by ___ of acutely or chronically involved joints or tophaceous deposits

A

needle aspiration

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11
Q

Present with similar clinical
features

A
  • Acute septic arthritis,
  • several of the other crystalline-associated arthropathies,
  • palindromic rheumatism,
  • psoriatic arthritis
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12
Q

seen both intracellularly and extracellularly during acute gouty attacks

A

needle-shaped MSU crystals

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13
Q

With compensated light, the needle-shaped MSU crystals are brightly

A

birefringent with negative elongation

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14
Q

In gouty arthritis, Synovial fluid leukocyte counts are

A

elevated from 2000 to 60,000/MI

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15
Q

Effusions appear ___ due to the increased numbers of leukocytes

A

cloudy

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16
Q

s of crystals occasionally produce

A

a thick pasty or chalky joint fluid

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17
Q

Excretion of___on a regular diet suggests that causes of overproduction of purine should be
considered

A

> 800 mg of uric acid per 24 h

18
Q

Cystic changes, well-defined erosions with sclerotic
margins (often with overhanging bony edges), and
soft tissue masses

A

advanced chronic tophaceous gout

19
Q

may aid earlier diagnosis by showing a
double contour sign overlying the articular cartilage

A

U/S

20
Q

can show specific features establishing the presence of urate crystals

A

Dual-energy computed tomography (CT)

21
Q

mainstay of treatment in acute attack of gouty arthritis

A

NSAID

22
Q

Tx of gout:

A
  • Ice pack applications and rest
  • Colchicine
23
Q

given as an intramuscular injection or orally for example, tapered with the resolution of the attack, can be effective in polyarticular gout

A

Glucocorticoids

24
Q

Tx for a single joint or a few involved joints,

A
  • intraarticular triamcinolone acetonide, 20—40 mg,
  • or methylprednisolone 25-50 mg
25
Q

Ultimate control of gout requires correction of the basic underlying defect:

A

hyperuricemia

26
Q

Attempts to normalize serum uric acid to ____ to prevent recurrent gouty attacks and eliminate tophaceous deposits are critical and entail a commitment to hypouricemic regimens and medications that generally are required for life

A

<300-360 umol/L (5.0-6.0 mg/dL)

27
Q

should be considered when hyperuricemia cannot be corrected by simple means

A

hypouricemic drug therapy

28
Q

decision to initiate hypouricemic therapy usually is made taking into consideration the :

A
  • number of acute attacks (urate lowering may be cost-effective after two attacks)
  • serum uric acid levels (progression is more rapid in patients with serum uric acid >535 umol/L
  • patient’s willingness to commit to lifelong therapy
  • presence of uric acid stones
29
Q

can be used in px with good renal function who underexcrete uric acid, with <600mg in a 24-h urine sample

A

Uricosuric agents such as probenecid

30
Q

Urine volume should be maintained by ingestion of ___of water every day

A

1500 mL

31
Q

can be started at a dose of 250 mg twice daily and
increased gradually as needed up to 3 g per day to achieve and maintain a serum uric acid level of <6mg/dL

A

Probenecid

32
Q

generally not effective in patients with serum creatinine levels >177 umol/L (2 mg/dL)

A

Probenecid

33
Q

Is another uricosuric drug that is more effective in
patients with chronic kidney disease

A

Benzbromarone

34
Q

s a newer uricosuric; however, it is approved only in patients already on a xanthine oxidase inhibitor as an adjuvant at 200 mg per day

A

Lesinurad

35
Q
  • most commonly used hypouricemic agent and is the best drug to lower serum urate in overproducers, urate stone formers, and patients with renal disease
  • The most serious side effects include:
  • life-threatening toxic epidermal necrolysis
  • systemic vasculitis
  • bone marrow suppression
  • granulomatous hepatitis
  • renal failure
A

Allopurinol

36
Q

40 or 80 mg once a day and does not require dose adjustment in mild to moderate renal disease

A

Febuxostat

37
Q
  • pegylated uricase, available for patients who do not tolerate or fail full doses of other treatments
  • given intravenously usually at 8 mg every 2 weeks and can dramatically lower serum uric acid in up to 50% of such patients
A

Pegloticase

38
Q

Urate-lowering drugs are generally not initiated during ____, but after the patient is stable and low-dose colchicine has been initiated to decrease the risk of the flares that often, without anti-inflammatory treatment, occur with urate lowering

A

acute attacks

39
Q

Colchicine anti-inflammatory prophylaxis in doses of 0.6 mg one to two times daily should be given along with the hypouricemic therapy until the patient is
normouricemic and without gouty attacks for

A

6 months or as long as tophi are present

40
Q

Should not be used in dialysis px and is given in lower doses to the px w/ renal disease or with P glycoprotein or CYP3A4 inhibitors such as clarithromycin that can incrase its toxicity

A

Colchicine

im immuno/rheuma (9 decks)

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