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23 Cards in this Set
- Front
- Back
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this is an inflammatory disease of peripheral joints caused by monosodium irate crystal deposits
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gout
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what is primary gout
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d/t inborn error in production and excretion of uric acid
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what is secondary gout
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d/t another disease, leukemia, renal or from drugs - salicylates, diuretics, nicotinic acid, alcohol
diet - liver, anchovies, organ meat, spinach, mushroom, cocoa, sweetbread, oatmeal |
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what is acute phase of gout
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sudden onset of joint inflammation and excruciating pain
one joint the MP of the big toe PODAGRA other sites: instep of foot, ankle, knee, wrist or elbow pain peak 24-36 hours symptoms subside without treatment days to few weeks |
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what are signs of acute gout
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warm tender red joint and possibly fever
very painful |
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what is chronic gout
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asymptomatic intervals become shorter and more joints involved, progressive
over time persistent symptoms of morning stiffness, synovial tissue thicken, joint deformity |
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what is tophi
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chalky deposits of sodium irate can develop at sites of irritation - achilles, tendon, joint of hands and pine
do not become visible for 10 years after onset of gout |
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what are extraarticular sx of gout
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low grade fever
chronic gouty neuropathy nephrolithiasis acute uric nephropathy |
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what are precipitating causes of gout, you should ask
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asprin intake
diuretic alchol change in diet - holidays number, duration and character of attacks associated sx with chronic gout - fever, back pain, nausea |
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what are some differentials for gout
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pseudogout - calcium
RA OA cellulitis infectious arthritis bursitis with bunion |
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what will you focus on your physical exam
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VS, temp, BP
palpate painful joint observe for tophi and chronic joint deformity |
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what diagnostic tests should you do
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always r/o infection
gold standard - joint aspiration to smear and cx for urate crystals hyperuricemia with typical monoarticular acute arthritis is sufficient xray to r/o other causes, can show punched out lesions - extra articular swelling Uric acid >7 ESR and WBC can be elevated if acute attack RF neg consider 24 hour to check uric acid |
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what is the acute phase treatment for gout
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NSAIDS high dose 2-3 days then decrease dose for 3-5 days
indocin - every 8 hours for 6-8 doses until resolved naproxen, celebrex, mobic goal: decrease uric acid and inflammation |
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what is second line treatment for acute phase
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colchicine - brand name only available Colcrys
use caution with renal dose depends on severity of symptoms give once, then every hour may have GI symptoms - diarrhea low dose steroids if NSAIDs do not work Medrol dose pack or prednison 2-3 days with 5-7day taper |
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what do you use for prophalaxis of gout
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daily NSAID or cohchicine
esp before surgery |
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what is the treatment for chronic gout
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urate lowering agent or hypouremic medications - allopurinol or probenecid
>3 attacks/year tophi X-ray show destructive joint severe hyperuremia >10 female >13 male, >15 in renal patients severe uric acid overproduction urate neuropathy with leukemia IF asymptomatic but high levels, just watch and wait continue low dose colchicine or NSAID for 2-12 mo |
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can you start urate lowering medication during acute attack
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no, must wait 2-4 weeks bc it will worsen symptoms
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what is the goal of uric acid level in the body
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<6.5
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what labs should you get before starting medication
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bun
creatnine lipid cbc |
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what is probenecid
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lower uric acid
increase renal excretion can combo with colchicine |
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what is allopurinol
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lowers uric acid - xanthine oxidase inhibitor
may potentiate anticoags, hypoglycemia, theophyline CHECK INR if on Coumadin start at 100mg/dl, then recheck level 2-4 weeks before adjusting TAKE with food |
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what is Feboxustat
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urate lowering med
non-purine selective xanthine oxidase inhibitor reduce production of uric acid do not start with acute attack goal <6 - uric acid |
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what are some patient education for gout
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reduce weight
reduce ETOH and purine intake avoid asa increase fluid 3L/day chronic gout is life long will monitor closely with high uric acid and no symptoms with acute attack, should be seen within 24 hours and return in 4 weeks to discuss maintenance |
