Gout

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  • Created by: sagalets
  • Created on: 15-05-17 23:31
What is gout?
A form of chronic metabolic arthritis characterized by uric acid crystal deposition in the joints causing inflammation and pain. Any joint in the body can be affected
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How is gout usually manifested?
Acute attacks first followed by formation of 'trophi' and chronic gout attacks
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What is primary and secondary gout?
Primary gout is caused by increased amount of uric acid in the organism and associated with obesity, alcohol drinking and purine rich diet. Secondary gout may be caused by impaired renal excretion and as a consequence of taking other drugs
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What medicines can contribute to the developmetn of secondary gout?
Diuretics, ciclosporins, levodopa
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What joints are primarily affected in gout?
Big toes, firgers, wrists
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What are 'trophi'?
Monosodium Urate Crystal (MSU) depositions in the joints that cause inflammation
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How do MSU promote inflammation in acute gout?
Monosodium Urate Crystals increase Sodium within the joint -> water influx -> swelling, potassium levels decrease -> inflammasomes increase IL-1 production and Toll-Like Receptors -> inflammation, vasodilation, cytokine and neutrophil recruitment
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What is pdeudo-gout?
Calcium depositions in bone, less severe pain than gout, affects mainly bigger joints (knee)
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What is the first-line treatment of acute gout?
NSAIDs
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What is the second-line treatmetn of acute gout?
Colchicine - a natural product extracted from colcicum plants, anti-inflammatory
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What are main concerns associated with Colchicine therapy?
Extremely toxic in overdose, metabolised by the liver. Can decrease blood count and cause GI disturbances and muscle weakness
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How does colchicine work?
Decreases TNF-alpha production, disrupts microtubules in neutrophils preventing their activation, decreases IL-1 processing and inhibits chemotaxins
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What is the first line preventative treatment for the recurrent gout attaks?
Allopurinol
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What class of drugs does Allopurinol belong to?
Xanthine Oxidase inhibitor
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What is the second line preventative gout treatment?
Febuxostat, XO inhibitor
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What is xanthine?
A soluble compound, product of purine metabolism that is oxidised to uric acid (insoluble)
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How is precipitation of urate in the joints manifested in a patient?
Temperature, dehydration, inflammation
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How is uric acid excreted?
Renally
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What is the third-line preventrative treatment for gout and how does it work?
Sulfinpyrazone, URAT-1 inhibitor. Stops reabsorption of uric acid in the PCT in the kidney
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What is the name for the class of drugs that facilitate uric acid extretion?
Uricosurics
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What is a natural uricosuric in the organism?
Oestrogen
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Why does apirin have to be avoided in gout?
It decreses excretion of uric acid into the kidney tubules
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How is patient started on Allopurinol?
The dose is gradually titrated up
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What if a patient on diuretics in diagnosed with gout?
Change loop/thiazide diuretics to losartan
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Non-pharmacological management of gout?
Rest, give ice pack. Change lifestyle and diet, lose weight. Stop smoking, increase exercise
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Card 2

Front

How is gout usually manifested?

Back

Acute attacks first followed by formation of 'trophi' and chronic gout attacks

Card 3

Front

What is primary and secondary gout?

Back

Preview of the front of card 3

Card 4

Front

What medicines can contribute to the developmetn of secondary gout?

Back

Preview of the front of card 4

Card 5

Front

What joints are primarily affected in gout?

Back

Preview of the front of card 5
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