Gout

Front 1

What is gout?

Back 1

Monoarticular inflammatory arthritis due to crystallization of MSU in joints

Front 2

What kinds of people are affected by gout?

Back 2

90% of patients are men over 30 years of age, women are not affected until after menopause

Front 3

What is the pathophysiology of gout?

Back 3

1) Increased production of uric acid (Lesch-Nyhan Syndrome due to HGPRT deficiency) or increased cell turnover from chemotherapy
2) Decreased excretion of uric acid (renal disease or diuretics)

Front 4

What are the clinical stages of gout?

Back 4

1) Asymptomatic hyperuricemia - increased serum uric acid level in the absence of clinical findings
2) Acute gouty arthritis - initial attack with sudden onset of exquisite pain, most often the 1st MTP (podagra)
3) Intercritical gout - asymptomatic period after initial attack; recurrence quite common
4) Chronic tophaceous gout - occurs in ppl with poorly controlled gout for more than 10-20 years; tophi are aggregation of urate crystals and inflammatory (giant), destruction/deformity of tissues and joints

Front 5

What are the common sites of involvement for gout?

Back 5

1st MTP, knee, ankle, midfoot, wrist, fingers, elbow

Front 6

How can you definitively diagnose gout?

Back 6

Joint aspiration and synovial fluid analysis; see needle-shaped and negatively birefringent urate crystals; serum uric acid can be normal even during acute gouty attack

Front 7

What are non-pharmacological methods to treat gout?

Back 7

Avoid secondary causes of hyperuricemia;
1) Avoid medications that increase uric acid levels (thiazide diuretics)
2) Obesity
3) Reduce alcohol intake
4) Reduce protein intake

Front 8

How do you treat acute gout?

Back 8

1) Bed rest
2) NSAID's (indomethacin is treatment of choice), effective at relieving pain
3) Colchicine - for patients who cannot take NSAIDs but severe side effects; nausea/vomiting, diarrhea and cramps causing reduced compliance
4) Corticosteroids - if no response to NSAIDs or colchicine; steroid injections can work as well

Front 9

How does prophylactic therapy of gout work?

Back 9

Wait til at least 2 or 3 acute gouty attacks before initiating prophylaxis; 2 attacks per year is a rough guideline
*Determine 24-hour urine uric acid dictates which drug to use
1) If <800 mg/day, indicates undersecretion of urate, give probenecid which inhibits renal urate resorption
2) If >800 mg/day, indicates over production, give Allopurinol to decrease uric acid synthesis via Xanthine oxidase inhibitor; NEVER give for acute gout

Front 10

How long does an acute gouty attack last if untreated?

Back 10

7-10 days

Front 11

What are the complications of gout?

Back 11

Tophaceous gout
Nephrolithiasis due to deposition of urate crystals in the urinary tract

Front 12

What are precipitants of an acute gouty attacK?

Back 12

Decrease in temperature, dehydration, stress, excessive alcohol intake and starvation, aspirin

Front 13

Is acetaminophen recommended for treatment of gout?

Back 13

No because it has no anti-inflammatory effects