Gout
This inflammatory cytokine is activated in gout flares through the NLRP3 inflammasome, driving the inflammatory response
Interleukin-1 beta
What is the gold standard to confirm the diagnosis of gout?
Demonstration of uric acid crystals following synovial fluid aspiration or arthrocentesis
What are three front-line pharmacologic agents used to treat acute gout?
Corticosteroids, oral colchicine, or NSAIDs
Based on the 2007 and 2008 National Health and Nutrition Examination Surveys, the prevalence of gout is threefold in this particular population
6% of the men and 2% of the women
3 Differential diagnosis of gout
Pseudogout, septic arthritis, reactive arthritis, cellulitis, traumatic arthropathy, and hemorrhagic arthropathy
What are treatment options in patients with renal failure and monoarticular involvement?
Intra-articular injection of steroids
This type of alcoholic beverage has the strongest dose-response relationship with incident gout, with higher consumption linked to a progressively greater risk
Beer
Differences between early disease and late disease
Early: olecranon bursitis, gout crystals, and podagra.
Late: prominent tophi and erosive damage
What population is at special risk for colchicine toxicity, and what are the common side effects?
Bone marrow toxicity and neuromyotoxicity in renal failure
What percentage of patients with gout have a normal serum uric acid level?
25%
3 Clinical risk factors for gout develops
Metabolic syndrome, renal disorders, hemolytic states, increased keratinocyte turnover, and increased neoplastic cell turnover
What serologic testing should be ordered before starting allopurinol in Asian and Black/African patients?
HLA B*5801
hypersensitivity syndrome
Monosodium urate crystal appearance
Needle-shaped, negatively birefringent crystals
What is the target level of serum uric acid should be achieved to prevent recurrent attacks of gout?
<6 mg/dl
3 precipitating medications for acute gout episode
ACE-inhibitors, ARB, Thiazide/loop diuretics, low dose aspirin, beta blockers, cyclosporine, tacrolimus