1. Disorder of purine metabolism that causes an overproduction

2. Disorder of urate elimination that causes an underexcretion

1. Diet

2. De Novo

3. Tissue Turnover

1. Meats, especially organs

2. Seafood

3. Coffee

4. EtOH

7.0 mg/dL

**You want below this amount to avoid gout**

In peripheral Tissues

Joints

Cartilage, tendons, ligaments

1. Age

2. Sex

False

Old> young

Male >female

1. Diet

2. Serum Uric Acid

3. EtOH intake

4. Rx

5. HT
6. Renal disease

7. Transplantation

8. Obesity

9. Metabolic Syndrome

No, even with a low purine food diet the best results you can obtain is a decrease in Urate by 1 mg/dL.  You need Rx.

Also adherence to this diet is very low!

1. Loop and Thiazide diuretics

2. Nicotinic Acid

3. Salicylates under 2G/day (low doses)

4. Ethyl Alcohol

5. Cyclosporines

1. Asymptomatic Hyperuricemia

2. Acute/recurrent Gout

3. Intercritical Gout

4. Chronic Tophaceous Gout

1. When UA > 10 mg/dL there is a  > 50% chance of getting gout

2. When UA excretion is > 1100 mg/day  there is a > 50% chance of nephropathy

1. Acute inflammation to a single joint

2. Fever

3. Intense pain

4. Erythema

5. Warmth and Swelling of joint

The 1st Metatarsaphalangeal (MTP) = big toe

can also effect the instep, ankeles, heels, knees, wrists, fingers and elbows

Deposits of Urate Crystals in soft tissue

Classic Tophus is in helix of ear

1. Soft Tissue Damage

2. Deformity

3. Joint Destruction

4. Nerve compression syndromes like Carpel Tunnel Syndrome

1. Terminate acute attack

2. Minimize risk of future attacks

3. prevent/reverse complications associated w/chronic crystal deposition

4. Prevent/reverse associated conditions like obesity, HT

Should get symptomatic relieft within 24 hrs.

Complete resolution in >90% of people within 5-8 days. 

1. GI ( bleeding, gastritis)

2. Renal (decreases CrCL, necrosis)
3. CV (increasing BP and fluid retention)

4. CNS (dizzy, headache, decrease cognition)

People with the following:

1. PUD
2. Uncontrolled HT

3. Renal insufficiency

4. CAD

5. Those on anticoagulants

1.2 mg at onset of attack followed by 0.6 mg 1 hr later.

The max dose is 1.8 mg

IV!

Can lead to alopecia, bone marrow suppression, Acute renal failure, liver failure, seizures, DEATH.

False;

You dont want to use an IV can lead to DEATH and other complications

1. GI (80% of peeps)

2. Bone Marrow Suppression

3. Motor problems

4. Toxicities

Fluid Retention

Weight gain

Impaired wound healing

Psychosis

HPA Suppression

Osteoporosis

Immunosuppression

True;

this is why we taper over 7-10 days

False;

Less effective

Intra-Articular or Systemic CS

ACTH is available

Caution w/use of Colchicine

1. 1-3 months before starting an Urate Lowering Therapy

2. If you have 2-3 attacks/yr or 1 severe attack

3. Serum Urate > 10 mg/dL

4. 24 hr Urate excretion > 1000 mg

5. If has complicated urate nephrolithiasis

1. Low dose Colchicine

2. Low dose NSAIDs

1. 3 or more attacks/yr

2. Urate is always > 11mg/dL

3. Radiographic changes

4. Tophaceous deposits

Underexcretors

Overproducers

Decrease the dose. 

CrCL of 60-90 mg/dl = 200 mg

CrCL of 30-59 mg/dl = 100

CrCL of < 30 mg/dl = 50-100 mg

1. Pruritis and mild rash (skin rxn)

2. Rare, severe, dose dependent hypersensitivity

that can cause liver/kidney failure, death, fever

1. Low dose ASA

2. Warfarin

3. Mercatopurine

4. Ampicillin

5. Thiazide Diuretics

6. Azathioprine

7. Theophylline

Take 40 mg Every day

Can increase to 80 mg after 2 weeks if the SUA is still > 6.0 mg/dL

1. Documented underexcreter

2. If CrCl > 50 ml/min

3. If not on low dose ASA

4. Have no nephrolithiasis

1. Nausea/vomiting

2. Allergic rxn

3. Urolithiasis

4. Anorexia

Hydrate!!! Drink 2-3 L/day

We also want to alkalinize the urine

1. NaHCO3/K Citrate

2. Citric Acid/Na Citrate

Losartan (for high B.P)

Fenofibrate (for high lipids)

Allopurinol

Uricosurics

500 mg 2x/day for 3-5 days

then 250 mg 2x/day for 2-3 days

800 mg 1x/day for 3-5 days

then 400 mg 1x/day for 2-3 days