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30 Cards in this Set
- Front
- Back
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what is the end product of purine metabolism in humans due to loss of uricase activities?
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uric acid
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what are the four evolutionary advantages of uric acid?
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anti-oxidant, BP control in times of low salt ingestion, intelligence, neurodegenerative protective effects.
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what is hyperuriciemia an independent risk factor for?
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atherogenesis
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why are inflammatory mediators produced in response to urate crystals?
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because the urate crystal are coated by IgG which stimilates the neutrophils, leukocytes, monocytes, fibroblasts, synoviocyte, and renal cell to produce inflammatory mediators.
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Out of all of the inflammatory mediators produced in response to urate crystals, which one is the most imporant in atherogenesis?
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oxygen radicals
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what lipoprotein inhibits urate crystals from initiating a production of inflammatory mediators?
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APOE
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what gender is most affected by hyperuricemia and gout before the age of 55? after?
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men; by 65 yoa both men and women are equal because after menopause women quickly catch up to men.
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what is the best predictor of acute gout?
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change in serum uric acid
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20 yoa female not currently on any medications with regular periods comes in complaining of joint pain and has a high serum uric acid level, what can you immediately rule OUT?
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an attack of gout
you will NEVER EVER see an attack of gout in a menstrating woman unless they are on diuretics. |
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anything that causes a shift of uric acid through the joint where polies may form will cause what?
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a precipitation of gout.
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what is the most common form of inflammatory arthritis in men >40 yoa?
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gout
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90% of hyperuriciemia cases are caused by? give examples
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underexcretion
renal defect, dec GFR, diuretics, tubular toxins, lead, hypothyroidism |
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what is the most common cause of hyperurecemia via overproduction?
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alcohol, esp beer consumption
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10% of hyperuriciemia cases are caused by? give examples.
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overproduction
HGPRTase/ PRPP synthestase, increase purine intake, alcohol, myeloproliferative dz, psoriasis |
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56 yo Male comes in complaining of recurring attacks of pain in 4 of his joints that has been going on every 2 weeks that last for a week. what stage is he in?
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stage II- last subcategory of stage II before it becomes stage III
-acute intermittent arthritis acute attacks: 1 week- 2 months intervals: 2-3 wks, 3-4 mos joints: 4-5 |
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59 yo male comes in complaining of pain in his knee that last for about a week, but happens once every couple of years. what stage is this guy in? what do you give him?
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stage II- 1st subcategory of stage II
-acute intermittent arthritis acute attacks: 1-2 weeks intervals: 2-10 yrs joints: 1-2 give him NSAIDs unless CI (HTN, GI problems) forman would give corticosteroids. |
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50 yo male comes into your office complaining of knee pain that lasted for 2 weeks and occurs every 6 months. what stage is he in?
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stage II- 2nd subcategory
-acute intermittent arthritis acute attacks: 1-3 weeks intervals: 6 months-2 yrs joints: 1-2 |
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how do you differentiate stage III gout from RA?
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by ordering an RF test. If it's positive then it must be RA.
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what is the 1st attack in acute gouty arthritis called? where is it usually located?
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podagra- 1st MTP
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what is a Tophi indicative of?
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chronic urate overload
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if a pt comes in with recurrent attacks of gout even though he is on a prophylaxis, what should you give him?
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a uric acid excreter like probenecid
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T/F
Cochicine changes uric acid level. |
FALSE
it does not change uric acid level. |
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what are the indications for urate lowering?
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tophacheaous disease w/ erosion
uric acid nephrolithiasis recurrent attacks despite prophylaxis to prevent acute cell lysis |
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89 yo male presents with oligoarthritis and linear or stippled calcifications on x-ray. What should be your #1 ddx? what other clinical features would confirm this ddx?
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- calcium pyrophosphate deposition disease (CPPD)
other clinical features: - multiplicity of presentations -superimposed one existing OA -knee, shoulder, wrist and MCPs |
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what are the five CPPD presentations?
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pseudogout, pseudo-RA, pseudo-OA, pseudo-neuropathic joints, and asymptomatic chondrocalcinosis
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what is chondrocalcinosis?
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calcification in the hyaline cartilage
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what are the associated medical conditions for CPPD?
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hyperparathyroidism, hypothyroidism, hemochromatosis, and hypomagnesemia
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what is the most frequently involved joint in pseudogout?
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knee
runner ups: hip wrist shoulder |
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what do CPPD crystals look like?
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rhomboid, weakly positively birefringent
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how do you manage crystal disease?
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NSAIDs and Corticosteroids. For chronic lowering of uric acid use allopurinol or febuxostat
can use colchicine as a prophylaxis (1 tab/ day) |
