Understanding Gout and Uric Acid Metabolism

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Questions and Answers

Which symptom is most characteristic of an acute gout attack?

  • Strange lumps around joints
  • Kidney stones
  • Rapidly worsening pain (correct)
  • Pain in the elbows

Which dietary component is primarily involved in the biosynthesis of uric acid?

  • Guanine
  • Cytosine
  • Adenine
  • Hypoxanthine (correct)

What is the relationship between diuretics and hyperuricemia?

  • Diuretics induce hyperuricemia by increasing urate reabsorption (correct)
  • Diuretics do not affect uric acid levels
  • Diuretics lower serum uric acid levels
  • Diuretics decrease urate reabsorption

Which test is utilized to detect the presence of crystals in the joint fluid for gout diagnosis?

<p>Joint aspiration and polarized light microscopy (D)</p> Signup and view all the answers

Which condition is associated with an increased risk for developing gout due to high cell turnover?

<p>Psoriasis (A)</p> Signup and view all the answers

What does a high erythrocyte sedimentation rate indicate in the context of gout?

<p>Possible presence of inflammation (C)</p> Signup and view all the answers

Which demographic group is more predisposed to gout?

<p>Older men (B)</p> Signup and view all the answers

What does the presence of tophi around joints indicate?

<p>Chronic gout (B)</p> Signup and view all the answers

What serum uric acid level is generally considered elevated?

<p>More than 10 mg/l (C)</p> Signup and view all the answers

Which of the following tests may show normal results during an acute gout attack?

<p>X-ray (C)</p> Signup and view all the answers

What is the primary goal of targeting serum uric acid levels in gout management?

<p>To help alleviate symptoms and prevent future attacks (A)</p> Signup and view all the answers

Why should aspirin be avoided in the treatment of gout?

<p>It alters uric acid levels and may intensify an acute attack (D)</p> Signup and view all the answers

What is the mechanism of action of colchicine in treating gout?

<p>Blocks neutrophil migration and reduces inflammatory glycoprotein production (D)</p> Signup and view all the answers

Which dietary practice is recommended for managing gout?

<p>Increased consumption of skimmed milk and unsaturated fats (A)</p> Signup and view all the answers

What is a significant concern when using colchicine in patients with renal insufficiency?

<p>Increased serum uric acid levels due to lower drug clearance (A)</p> Signup and view all the answers

Which COX-2 inhibitor is suggested for patients unable to tolerate conventional NSAIDs?

<p>Etoricoxib (D)</p> Signup and view all the answers

What defines the therapeutic index of colchicine?

<p>It has a narrow therapeutic index, increasing the risk of toxicity (C)</p> Signup and view all the answers

What mechanism does allopurinol use to lower uric acid levels in the body?

<p>Inhibits xanthine oxidase, decreasing uric acid formation (C)</p> Signup and view all the answers

What is a common initial sign of colchicine toxicity?

<p>Gastrointestinal intolerance like diarrhea or nausea (A)</p> Signup and view all the answers

What is the recommended lifestyle change for obese patients with gout?

<p>Implement weight loss strategies to lower gout risk (C)</p> Signup and view all the answers

Which statement about allopurinol is correct?

<p>Its use may lead to Steven Johnson syndrome in the initial months of treatment. (B)</p> Signup and view all the answers

What is a contraindication when prescribing febuxostat?

<p>Use in patients with ongoing chemotherapy. (B)</p> Signup and view all the answers

What is a significant risk associated with uricosuric agents?

<p>They expose patients to a risk of uric acid stones, especially at treatment onset. (A)</p> Signup and view all the answers

Which of the following is true regarding lesinurad?

<p>Lesinurad acts as a uricosuric agent by inhibiting URAT1. (D)</p> Signup and view all the answers

What are the potential side effects of febuxostat?

<p>Nausea, vomiting, joint stiffness, and headaches. (C)</p> Signup and view all the answers

Which pathway is associated with the pathogenesis of gouty arthritis?

<p>ATP signaling through P2X7R receptors. (D)</p> Signup and view all the answers

What is the effect of allopurinol on uric acid?

<p>It inhibits the metabolism of purines, thus reducing uric acid levels. (C)</p> Signup and view all the answers

Which of the following is a common reason for caution when prescribing febuxostat?

<p>Increased risk of cardiovascular side effects compared to allopurinol. (D)</p> Signup and view all the answers

How should uricosuric agents be used in patients with a history of uric acid stones?

<p>They should be avoided as monotherapy. (B)</p> Signup and view all the answers

What distinguishes febuxostat from allopurinol?

<p>Febuxostat does not require renal adjustment in moderate renal failure. (A)</p> Signup and view all the answers

Flashcards

Gout

A condition caused by the buildup of uric acid crystals in your joints, leading to sudden, severe pain and inflammation.

What is Gout?

A type of inflammatory arthritis characterized by sudden, severe pain in the joints, typically in the big toe, knees, ankles, wrists and elbows.

Uric Acid Biosynthesis

The process by which uric acid is produced in the body. It starts with dietary intake of purines, which are broken down into uric acid via the enzyme Xanthine oxidase.

Uric Acid

A chemical compound present in our body that is produced during the breakdown of purines. High levels can contribute to gout.

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Purines

A natural substance found in many foods. They are broken down into uric acid in the body.

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Xanthine Oxidase

A type of enzyme critical in the production of uric acid. It converts xanthine into uric acid.

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Tophi

Deposits of uric acid crystals that can form around joints in people with gout. They are small, hard lumps that can be painful.

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Rapidly Worsening Pain

Pain that comes on suddenly and gets worse quickly.

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Kidney Stones

Stones that form in the kidneys, sometimes caused by high uric acid levels.

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Alcohol

A common cause of gout. It can lead to increased uric acid levels in the body.

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Lifestyle Management for Gout

Maintaining a healthy weight, regular exercise, and avoiding alcohol and sugary drinks.

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Urate-lowering Drugs

Medications that lower the amount of uric acid in the body.

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NSAIDs (Nonsteroidal Anti-inflammatory Drugs)

A class of drugs that reduce inflammation and pain, commonly used for gout attacks.

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Colchicine

A drug that inhibits the production of inflammatory substances, effectively reducing gout symptoms.

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Allopurinol

A drug that works by inhibiting xanthine oxidase, leading to decreased uric acid production.

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COX-2 Inhibitors

A type of NSAID that selectively blocks the production of pro-inflammatory prostaglandins.

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Hyperuricemia

A buildup of uric acid in the blood, often leading to gout attacks.

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Gout Attack

A painful and swollen joint, typically the big toe, caused by the buildup of uric acid crystals in the joint.

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Febuxostat

A non-purine xanthine oxidase inhibitor that is more potent than allopurinol. Reduces uric acid levels but is contraindicated with certain chemotherapeutic drugs due to its mixed metabolism.

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Uricosuric Agents

A class of drugs that reduce uric acid levels by increasing its excretion in urine. Examples include probenecid, benzbromarone, and sulfinpyrazone.

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Lesinurad

A selective URAT1 inhibitor used as an add-on therapy when other drugs fail to lower uric acid levels.

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P2X7R

A receptor that is activated by ATP, contributing to the development of gouty arthritis by increasing inflammation.

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ATP

A chemical that promotes inflammation and plays a role in gouty arthritis. It triggers the P2X7R receptor.

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P2X7R Polymorphisms

Genetic variations in P2X7R function can be linked to the development of gouty arthritis.

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ATP-P2X7R Signaling

The signaling pathway involving ATP and its receptor (P2X7R) plays a crucial role in the progression of gout.

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Stevens-Johnson Syndrome (SJS)

A rare but serious skin reaction that can occur with allopurinol. It usually appears within the first few months of treatment.

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Skin Reactions to Febuxostat

A common side effect of febuxostat that affects the skin. It is more likely in people who had skin reactions to allopurinol.

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Study Notes

Gout

  • Gout is a condition where excess uric acid crystals accumulate in joints, causing pain and inflammation.
  • Symptoms include intense joint pain, redness, swelling, and tenderness.
  • Uric acid is a byproduct of purine metabolism.
  • High levels of serum uric acid (greater than 10mg/L) are not always indicative of gout.
  • Normal serum uric acid levels are less than 7 mg/L
  • Diagnosis involves joint aspiration and light microscopy to detect crystals.
  • Full blood count with elevated white blood cells typically indicates inflammation.
  • Erythrocyte sedimentation rate helps assess inflammation; a faster-than-normal rate suggests inflammation.
  • X-ray can show signs of acute gout (e.g., joint inflammation).

Uric Acid Biosynthesis

  • Uric acid is formed from dietary intake and purine bases and cell breakdown.
  • Hypoxanthine is a precursor in the process.
  • Xanthine oxidase is an enzyme that converts hypoxanthine to xanthine and then to uric acid.
  • Uric acid is excreted by the kidneys.

Predisposition

  • Males are more susceptible than females to gout.
  • Family history increases the risk.
  • Body size (larger) increases risk.
  • Diet high in purines increases risk.
  • Alcohol consumption is a risk factor.
  • Diuretics can cause hyperuricemia.
  • Diseases/treatments that cause high cell turnover (e.g., psoriasis, chemotherapy) can contribute.
  • Impaired renal function increases the risk of gout.

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