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Documente Profesional
Documente Cultură
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Silent
tissue
deposition
Gout
Renal
manifestations
Associated
cardiovasclular
events and
mortality
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Gout
One Chronic Disease, Best described by 4 Stages
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Asymptomatic
hyperuricemia
Acute flares
Elevated serum
urate with no
clinical gout
Acute
inflammation
from urate
crystallization
Intercritical
segments
Intervals
between
flares
Advanced gout
Long-term gouty
complications of
uncontrolled
hyperuricemia
Uncontrolled hyperuricemia
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1.
2.
3.
4.
5.
Acute flare
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Clinical manifestations
Of an Acute Gout Flare
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. Abrupt onset severe joint inflammation,
often at night
- Warmth, swelling, erythema, and pain
- Fever may occur
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Intercritical Segments
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Asymptomatic intervals between flares
- Gout clinically inactive
Disease, if untreated, may continue to advance
- Intercritical segments may shorten over time
- Crystals may still be found in asymptomatic joints
- Uncontrolled hyperuricemia continues to increase body
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urate stores
Advanced Gout
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Advanced Gout
Chronic Arthritis and Acute Flares
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. Chronic arthritis
- Joints are persistently uncomfortable, stiff, and swollen
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Advanced Gout
Tophaceous Deposits
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Diagnosing Gout
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. Male gender
. Female gender postmenopause
. Advanced age
. Drugs
- Diuretics, low-dose aspirin (ASA), cyclosporine
. Hypertension
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. Transplant
. High alcohol intake
- Highest with beer, followed by liquor
- No increased risk with wine
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The Importance of a
Differential Diagnosis
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Think about gout before diagnosing other
diseases with different and/or less specific therapies
- Pseudogout-Calcium
- Rheumatoid arthritis (RA)
pyrophosphate
. Nodules potentially
deposition
confused with
disease (CPPD)
tophi
. Chrondrocalcinosis
- Osteoarthritis
. Rhomboid-shaped
- Septic arthritis
crystal
- Cellulitis
- Psoriatic Arthritis
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progression
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Considerations
. Contraindicated in peptic ucler disease, GI bleeds,
history of aspirin or NSAID-Induced asthma, renal
dysfunction
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Corticosteroids
And ACTH
. Worsening of glycemic control in diabetics
. May need to add other anti-inflammatories or use
moderate-to-high doses
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Advantage
. Reverses most common physiologic
abnormality in gout
- ~90% of patients are underexcretors of uric acid
Allopurinol
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Uricosurics
Drug interaction
Risk of nephrolithiasis
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. Dietary trends
. Improved survival from comorbidities
. Limitations in treatment
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. Heart failure
. Hyperlipidemia
. Hypertension
. Cardiovascular disease
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Summary
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. Gout needs to be
- Accurately diagnosed
- Recognized as a chronic disease with 4 stages
- Treated separately for
. Terminating acute flares
. Controlling chronic hyperuricemia and tissue
deposition
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Teaching Points
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. Hyperlipidemia
. Metabolic syndrome
. Hypertension
. Diabetes mellitus
. Renal disease
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. Heart failure
Teaching Points
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Risk factors for hyperuricemia and gout
. Heredity
. Transplanation
. Male gender
. Postmenopause
. Advanced age
. Medications
- Cyclosporine
. High alcohol intake
- Liquor, Beer
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. Diet
Teaching Points
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. Gout
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Treatment Goals
1.Termination of the Acute Flare
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. Anti-inflammatory medication to suppress
crystal-induced inflammation
- Not a cure for gout
. Resolves the symptoms
. Urate crystals remain in the joint
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critical as:
. Appropriate dose of therapy
. Appropriate duration of therapy
Treatment Goals
2. Anti-inflammatory Therapy to
Prevent Further Flares
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Imaging
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Imaging (continuing)
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X-Ray
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Treatment Goals
3.Urate-lowering Therapy to Prevent
Flares and Disease Progression
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Conclusion
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