LCT: connective tissue disorders: Gout

maintenance therapy for chronic gout

Allopurinol is 1st line

Gout

a type of arthritis characterized by elevation of uric acid and deposit of uric acid crystals in 1 or more joints

A client is diagnosed with acute gouty arthritis. Which medication would the health care provider prescribe to treat the acute attack of gout and prevent future attacks?

colchicine

what does allopurinol do

decreases uric acid production is tx for chronic gout, usually

Low-purine diet

eat more: -fruits -vegetables -whole grains -low-fat dairy -legumes -nutes eat less: -shellfish -organ meats (liver) -alcoholic beverages -soft drinks

which parts of the body might you see tophi

feet ears hands

pt with DMII is dx with gout. - what do they need to know about the use of allopurinol

monitor blood glucose levels more frequently - allopurinol can potentiate the effects of oral hypoglycemics, causing hypoglycemia

*people with gout more likely to get what type of kidney stone*

uric acid kidney stone

drug therapy for acute gout

- PO colchine and NSAIDs - PO or intraarticular steroid injections during flare up -Pt education: meds, diet -supportive care r/t pain

secondary gout pathophysiology

-hyperuricemia r/t increased production or decreased excretion of uric acid --other disease processes (kidney disease or certain carcinomas) --medications: loop diuretics, beta blockers, immunosuppressants --increased intake of food containing purines (red meats, organ meats, anchovies, sardines, shellfish) --excessive alcohol intake --PTs often have metabolic syndrome (obesity, hyperinsulinemia, insulin resistance, HTN, hyperlipidemia)

Clinical manifestations

-inflammation of one or more joints --> --great toe is most common --joints may appear dusty or cyanotic --pain/swelling can be sudden and severe, typically at night --attack ends in 2-10 days with or without treatment (no symptoms between attacks, about 12 flare-ups per year) --chronic gout: multiple joint involvement and visible deposits of sodium urate crystals (tophi) --can lead to kidney stone formation

primary gout pathophysiology

-most common -hereditary error of purine metabolism which allows excess production of uric acid, faster than can be excreted by the kidneys

Diagnostics

-serum uric acid higher than 6 mg/dL -24hr urine for uric acid -synovial fluid aspiration -clinical symptoms -x-ray of affected joint