part 3 spcon module 3

WHAT CONDITION IS THIS?

● Represents a heterogenous group of metabolic disorders

● Elevated level of uric acid

● Deposition of urate crystals in the joints, soft tissues and kidneys

● Most common crystalopathy (crystal-induced arthritis) in the US

● GOUT

What are the 3 groups in Gouty Arthritis?

PRIMARY HYPERURICEMIA

SECONDARY HYPERURICEMIA

IDIOPATHIC HYPERURICEMIA

This is one of the 3 groups of Gouty Arthritis

• inherited disorder of uric acid metabolism

PRIMARY HYPERURICEMIA –

This is one of the 3 groups of Gouty Arthritis

• occurs as a result of some metabolic problems such as G6PD Deficiency, reduced renal function, certain medications that blocks uric acid excretion, neoplasms)

SECONDARY HYPERURICEMIA

This is one of the 3 groups of Gouty Arthritis

• encompasses conditions that do not fit into either of the categories

• IDIOPATHIC HYPERURICEMIA –

In Gouty Arthritis,

ETIOLOGY & RISK FACTORS

• Family history

• Urate overproduction

  • _____, ______, _____, _____, _____

• Decrease uric acid excretion

  • ______

  • ______

  • ______

  • ______

  • ______

• Diet rich in _____ (nitrogen-containing compounds like shellfish, anchovies, asparagus, beans and sprouts)

• Ingestion of fructose-sweetened foods and beverages

  • ______ is the only sugar known to elevate uric acid levels

In Gouty Arthritis,

ETIOLOGY & RISK FACTORS

• Family history

• Urate overproduction

  • Leukemia, psoriasis, lymphoma, hemolytic disorders

• Decrease uric acid excretion

  • Heavy alcohol consumption (beer)

  • Obesity

  • Medications (thiazide diuretics, levodopa, salicylates)

  • Hypertension

  • Hyperparathyroidism

• Diet rich in purines (nitrogen-containing compounds like shellfish, anchovies, asparagus, beans and sprouts)

• Ingestion of fructose-sweetened foods and beverages

  • Fructose is the only sugar known to elevate uric acid levels

In Gouty Arthritis,

PATHOGENESIS

● Uric acid is formed form the breakdown cellular products of _____ — dissolves in the _____ and passes through the _____ then excreted to the urine

● Uric acid level becomes high – _____ cannot filter – uric acid precipitates out and accumulate in the _____ forming supersaturated body fluids

● Lodges in the articular cartilage, epiphyseal bone and periarticular structures that triggers an _____

● Results from interaction between _____ and _____

● Involves activation of _____ and _____ inflammatory mechanism

● Activation of _____

● Phagocytosis of crystals by _____

● Urate crystals will release _____, _____

In Gouty Arthritis,

PATHOGENESIS

● Uric acid is formed form the breakdown cellular products of purine — dissolves in the blood and passes through the kidneys then excreted to the urine

● Uric acid level becomes high – kidney cannot filter – uric acid precipitates out and accumulate in the body tissues forming supersaturated body fluids

● Lodges in the articular cartilage, epiphyseal bone and periarticular structures that triggers an inflammatory response

● Results from interaction between urate crystals and polymorphonuclear leukocytes

● Involves activation of humoral and cellular inflammatory mechanism

● Activation of bradykinin

● Phagocytosis of crystals by leukocytes

● Urate crystals will release prostaglandins, interleukins

In Gouty Arthritis, there are four stages in Clinical Manifestations. What are these?

● Asymptomatic hyperuricemia

● Acute Gouty Arthritis

● Intercritical period

● Chronic Gout

In Gouty Arthritis, which among the 4 stages is this?

• Serum urate of more than 7mg/dl

• Asymptomatic hyperuricemia ○

In Gouty Arthritis, which among the 4 stages is this?

○ Acute monoarticular, inflammatory arthritis and exquisite joint pain – most common clinical presentation

○ 1st MTP – common site of pain

○ Ankle, knee, wrist and elbow

○ Local intense pain of quick onset

○ Erythema and local tenderness

○ Chills and tachycardia

Acute Gouty Arthritis

In Gouty Arthritis, which among the 4 stages is this?

○ After recovering from the initial episode where patient becomes asymptomatic

○ Can last to months and years

○ Persistent hyperuricemia

○ Synovial fluid contains monosodium urate crystals ○ Gouty attacks may return suddenly (increase in frequency and severity)

○ Precipitated by trauma, surgery, alcohol consumption or overindulgence of foods containing high purine

● Intercritical period

In Gouty Arthritis, which among the 4 stages is this?

○ Characterized by joint damage, functional loss and disability

○ Deposits of monosodium urate crystals in soft tissue (TOPHI) and bone abnormalities (hallmark of the disease)

● Chronic Gout

In Gouty Arthritis, what condition is this?

⤷ Deposition of calcium pyrophosphate dihydrate (CPPD) in articular cartilage, synovium, and periarticular ligaments and tendons

⤷ Common in elderly (65-75 y/o)

⤷ May be asymptomatic

Pseudogout

Pseudogout

⤷ Deposition of __________ in articular cartilage, synovium, and periarticular ligaments and tendons

⤷ Common in elderly (65-75 y/o)

⤷ May be asymptomatic

Pseudogout

⤷ Deposition of calcium pyrophosphate dihydrate (CPPD) in articular cartilage, synovium, and periarticular ligaments and tendons

⤷ Common in elderly (65-75 y/o)

⤷ May be asymptomatic

In Gouty Arthritis, this is presumptive of CPPD deposition

Chondrocalcinosis

In Gouty Arthritis, this medication is:

■ First line of treatment to lower level of urate in the blood

■ Lessen level of symptom and future attacks by slowing the rate of uric acid synthesis

○ Xanthine Oxidase inhibitors (allopurinol)

In Gouty Arthritis, this medication has anti-inflammatory effect but with narrow therapeutic range

Colchicine ○