Term
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Definition
-an inflammatory arthritis caused by uric acid and crystal deposits
-red, swollen, and acutely painful joints
-mostly affects feet, great toe, ankle, and midfoot
-pt may be asymptomatic for years in between attacks
-first acute attack strikes suddenly and peaks quickly
-chronic polyarticular gout is the final stage of the disease marked by persistent painful polyarthritis |
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Term
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Definition
-Gout accounts for approximately 5% of all cases of arthritis.
-9 times more common in men
-Gout attacks usually affects men in their 40’s and 50’s
-More common in women after menopause
-Gout attacks are common in individuals that have kidney disease. |
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Term
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Definition
Disorder of purine metabolism
Gout occurs when the final metabolite uric acid crystallizes in the form of monosodium urate, precipitating in joints, on tendons and in surrounding tissue
These crystals then trigger a local immune- mediated inflammatory reaction with one of the key proteins in the inflammatory cascade being interleukin1 beta that causes a loss of uricase. Uricase breaks down uric acid and when uricase is not available an elevation of uric acid is produced . |
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Term
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Definition
| due to enzyme defects resulting from over production of uric acid, inadequate elimination of uric acid by the kidney, or both. In most cases the cause is unknown. |
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Definition
| the accompany arthritis is not the main disorder. Hyperuricemia may be caused by lymphoma, leukemia, chronic renal disease, diuretics and other disorders. |
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| Causes of uric acid buildup |
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Definition
High intake of purine rich foods (red meat and shellfish)
High alcohol intake( particularly beer and wine)
Genetics (passed down from one generation to the next)
Obesity
High blood pressure
Medication( diuretics, aspirin and chemotherapy treatment) |
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Term
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Definition
High level of uric acid in the blood (>7.0mg/dL )
Uric acid crystals in joint fluid
Uric acid crystals around joints (feet, ankles, knees, hands, wrist, elbows and ears)
Initially one or two joints are affected
The most common affected areas are the feet, ankles and the ball of the great toe.
The skin around the affected joint is red, shiny, and painful.
Tenderness around affected joint |
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Term
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Definition
A rapid onset usually between 12-24 hours
Often occurring overnight while the individual is in bed resting
Fever or chills
Fast subsidence ( gout attacks normally subside within hours or days) |
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Term
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Definition
CBC ( elevated white blood cell count)
Erythrocyte sedimentation rate(ESR) (elevated with inflammation)
Serum uric acid level(uric acid level greater than 7.0mg/dL
24-hour urine uric acid excretion greater than 900mg/24 hours
Rheumatoid factor titer
X-Ray
Joint fluid aspiration for urate crystals( Gold Standard) |
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Term
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Definition
1st Line Nonsteroidal anti-inflammatory (NSAID)
Naproxen500mg po bid for 10-14 days
Ibuprofen 800mg po tid for 10-14 days
Indomethacin 25-50mg tid for 10-14 days
2nd Line Colchicine
Colchcine 0.6mg po every hour max 3mg/day Colchicine must be taken within 24 hours of acute attack to be effective. Be aware of drug interactions and contraindications
3rd Line Corticosteroid
Prednisone 1mg/kg orally given as a single dose
Prednisone 20-40mg po once daily decrease by 5-10mg every 3 days until discontinuation. |
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Term
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Definition
1st Line Allopurinol
Allopurinol 100mg po once daily initially, increase by 100mg/day increments every week; max 800/mg/day
1st Line Febuxostat
Febuxostat 40-80mg po once daily
2nd Line Probenecid
Probenecid 250mg-1000mg po bid |
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Term
| Patient teaching for Gout |
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Definition
Instruct patient to use warm or cool compresses to affected joints for comfort
Avoid weight bearing objects on the affected joints
Take medication as prescribed
Rest joints during attacks
Drink 10-12 glasses of water a day
Refrain from alcohol(worsen symptoms or trigger a new attack)
Weight loss program
Avoid crash diets
Avoid sardines, anchovies, shell fish, kidneys, liver, mushrooms, aspirin products, diuretics |
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Term
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Definition
Patient should be contacted within 24hours of starting treatment to monitor for sensitivity to medication
Follow up visit in 1 month to reevaluate status
Obtain yearly uric acid levels before initiating long –term therapy, obtain baseline blood urea nitrogen, serum lipid profile, and CBC. |
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Term
The gold standard test for diagnosing gout
A. Serum uric acid level greater than 7.0mg/dl
B. Joint fluid aspiration for urate crystals
C. 24 hour urine uric acid excretion less than 900mg/24hours
D. Rheumatoid factor titer |
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Definition
| B. Joint fluid aspiration for urate crystals |
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Term
A patient recently diagnosed with gout will receive all of the following discharge information except:
A. Take aspirin to relieve joint pain as needed.
B. Increase fluid intake to at least 8 glasses of water daily.
C. Refrain from alcohol (beer, wine, liquor)these will worsen your symptoms.
D. Avoid organ foods, liver kidneys, anchovies, sardines and shell fish. |
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Definition
| A. Take aspirin to relieve joint pain as needed. |
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Term
All the medications listed below is used to treat acute gout except:
A. Ibuprofen
B. Colchicine
C. Allopurinol
D. Corticosteroid |
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Definition
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