Term
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Definition
| a specific form of arthritis that is triggered by deposition of monosodium urate crystals in joints; hallmark biochemical feature is hyperuricemia |
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Term
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Definition
| has no physiologic function but is the major end product of purine metabolism |
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Term
| Factors that lead to increased levels and catabolism of purines which can increase uric acid formation |
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Definition
| high purine diet, heavy alcohol consumption, surgery, certain drugs |
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Term
| Normal values for plasma urate/uric acid |
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Definition
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Term
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Definition
| has pKa of 5.7; at physiologic pH, its solubility is such that urate crystals can begin to precipitate at uric acid concentrations that are just above normal range |
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Term
| Factors Contributing to Development of Hyperuricemia & Gout |
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Definition
| heredity, diet, alcohol, low fluid intake, cancer, radiation therapy, drugs (aspirin, diuretics, sulfonamides, antineoplastics, l-DOPA) |
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Term
| Areas of the body that sodium urate crystals form |
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Definition
| areas of body that are cooler than core body temperature (toes, feet, ankles, fingers, hands) |
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Term
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Definition
| asymptomatic hyperuricemia; acute gouty arthritis; intercritical (interval) gout; chronic tophaceous gout |
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Term
| Steps in Acute Gout Attack |
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Definition
| 1) sodium urate crystals form in joint; 2) phagocytosis by neutrophils & macrophages; 3) neutrophil activation & release of inflammatory mediators triggers severe inflammatory reaction, urate crystals form |
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Term
| Symptoms from Acute Inflammation of Gout |
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Definition
| severe pain; redness; swelling; fever; increased sedimentation rate; may be mistaken for an abscess or septic arthritis |
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Term
| Treatment of Gout by Suppressing Acute Attack |
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Definition
| NSAIDS (indomethacin, ibuprofen); colchicine; corticosteroids (prednisone & methylprednisone) |
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Term
| Treatment of Gout by Increasing Excretion of Uric Acid |
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Definition
| probenacid (Benemid); sulfinpyrazone (Anturane) |
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Term
| Treatment of Gout by Inhibiting Formation of Uric ACid |
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Definition
| allopurinol (Xyloprim); febuxostat |
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Term
| Treatment of Gout by Facilitating Breakdown of Uric Acid |
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Definition
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Term
| NSAIDs - indomethacin (Indocin) & ibuprofen (Motrin) |
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Definition
| these agents have good antiinflammatory activity & can stop acute gout attacks in many cases; MoA: inhibits prostaglandin synthesis; SEs: GI irritation, CNS side effects (headache, drowsiness, dizziness, confusion) from 1 drug; avoid use of aspirin because its biphasic effect on uric acid excretion |
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Term
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Definition
| unique antiinflammatory activity that is specific for gout; MoA: binds to tubulin & prevents it's polymerization to microtubules, leads to reduction in leukocyte migration, phagocytosis, & mitosis, also inhibits production & release of proinflammatory glycoproteins from neutrophils; SEs: diarrhea (very severe), GI upset (nausea, vomiting); traditionally has been preferred drug for alleviating acute gout attack but now is 2nd line option to NSAIDs and corticosteroids |
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Term
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Definition
| inhibits xanthine oxidase and reduces formation of uric acid; lowers level of uric acid below its limit of solubility, keeping sodium urate crystals from forming & facilitate dissolution of existing crystals; does NOT STOP an acute gout attack but over time it can greatly reduce potential for future attacks; SEs: generally well-tolerated, increased frequency of gout attacks during early stages of therapy, elevation of liver enzymes, allergic reactions; Preferred drug treatment in pts with existing kidney stones (gouty nephropathy) |
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Term
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Definition
| uricosuric agent: inhibits both secretion & reabsorption of organic acids, net effect = increase uric acid excretion; SEs: generally well tolerated, GI upset, skin rashes, overdose - CNS effects (seizures & death), causes increased risk of stone formation in kidneys as concentration of urate in tubular fluid/urine rises; C/I in pts with kidney stones (gouty nephropathy); not effective for treating acute attacks; Consume adequate amounts of fluids to maintain urine flow & prevent formation of urate crystals in kidney |
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Term
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Definition
| all meats & seafood; meat extracts & gravies; yeast & yeast extracts, beer, & other alcoholic beverages; beans, peas, lentils, oatmeal, spinach, asparagus, cauliflower, & mushrooms |
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