GOUT : PATHOGENESIS, CLASSIFICATION, CLINICAL COURSE, AND MCQs WITH ANSWER

INTRODUCTION :-

1.) It is caused either due to excessive formation of uric acid, or inability to excrete it.

2.) It get deposited in joints as monosodium salt.

3.) Gout is a disorder of purse metabolism manifested by the following features occurring singly or in combination :

• Increased serum uric acid concentration ( hyperuricamia ).
• Recurrent attacks of characteristic type of acute arthritis in which the crystals of monosodium urate monohydrate may be demonstrated in the leukocytes present in the synovial fluid.
• Aggregated deposits of monosodium urate monohydrate ( tophi ) in an around the joints.
• Renal disease involving interstitial tissue and blood vessels.
• Uric acid nephrolithiasis ( the process of forming kidney stone ).

4.) This disease affect men more often than women.

CLASSIFICATION OF GOUT :-

A.] PRIMARY GOUT : Enzymes defects are unknown in 85 – 90% of primary gout. Overproduction of uric acid, normal excretion, increased excretion, underexcretion of uric acid with normal production, overproduction of uric acid are some of the metabolic defects. Primary gout is 90% of all cases.

B.] SECONDARY GOUT : 10% of all cases. It is associated with increased nucleic acid turnover and inborn error of metabolism. Overproduction of uric acid with increased urinary exertion, reduced excretion of uric acid with normal production, overproduction of uric acid with increased urinary excretion are some metabolic defects.

PATHOGENESIS :-

1.] Many factors play a role in the conversion of asymptomatic ( producing or showing no symptoms ), hyperuricemia ( excess uric acid in blood ) into primary gout. Some of these are :-

• Age of the individual and the duration of the hyperuricemia.
• Genetic factor.
• Heavy alcohol consumption.
• Obesity.
• Predisposition of certain drugs. Fir example : Thiazides.

2.] Central to the pathogenesis of the arthritis is precipitation of monosodium urate ( MSU ) crystals into the joints.

3.] Synovial fluid is a poorer solvent of MSU than plasma, and so with the hyperuricemia the urates in the joint fluids become supersaturated, particularly in the peripheral joint where the temperature is as low as 20°C in the ankle.

Fig : 1

CLINICAL COURSE :-

1.] The natural history of gout passes through four stages :-

• Asymptomatic hyperuricemia.
• Acute gouty authorities.
• Intercritical gout.
• Chronic tophaceous gout.

2.] Certain medicines like analgesics, uric acid reducers, non steroidal – inflammatory drugs are also given.

• Colchicine
• Corticosteroids
• Probencid
• Sulfinapyrazone
• Allopurinol
• Febuxostat

MULTIPLE CHOICE QUESTIONS :-

1.] Which of the following is not a first – line option for the pharmacological treatment of gout gout ?

a. NSAIDS

b. Corticosteroids

c. Oral colchicine

d. Aspirin

2.] How long after the onset of an acute gout attack should pharmacologic therapy be initiated ?

a. Within 1 hour

b. Within 24 hour

c. After 24 hour

d. After 48 hour

3.] Ice packs can be effective adjuncts to the management of an acute gout attack ?

a. True

b. False

4.] Which if the following is the recommended first – line therapy to consider ?

a. Febuxostat

b. Allopurinol

c. Probenecid

d. Benzbromarone

5.] Gout is caused by the buildup of what substance in the body ?

a. WBC

b. Synovial fluid

c. Uric acid

d. Blood plasma

6.] Uric acid is usually eliminated from the body by way of ?

a. Breathing

b. Urine

c. Metabolization of liver

d. Sweat

7.] People with gout should avoid consuming ?

a. Alcohol

b. Dairy products

c. Both (a) and (b)

d. None of these

8.] Symptoms of gout may include ?

a. Warmth, severe pain and swelling in the joint

b. Red or purple skin

c. Peeling, itching skin at the site of gout attack

d. All of the above

9.] What is most common site of gout attack ?

a. Big toe

b. Foot

c. Knee

d. Ankle

10.] What increases a person risk for developing gout ?

a. Family  history ( genetics )

b. High – salt diet

c. Asthma

d. All of the above

SOLUTIONS :-

1.] (d) aspirin

2.] (b) within 24 hours

3.] (a)

4.] (b) allopurinol

5.] (c) uric acid

6.] (b) urine

7.] (a)alcohol

8.] (d)

9.] (a) big toe

10.] (a) family history ( genetics )

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REFERENCES :-

1.] Textbook Of Pathology By Harsh Mohan.

2.] Robbin’s Basic Pathology.