Gout Assignment You will have 90 days from the start of this course to successfully complete it. When finished, fax your answers to TLC along with the Registration Form and Customer Survey (928) 468-0675. You can find 24-hour course assistance under the Assignment Page on TLC’s website under the Assistance Page. 1. What is the diagnosis of the photograph? Gouty tophi 2. What blood test would you perform? Serum uric acid 3. What ocular signs may be present? Conjunctivitis 4. Give two medications that are available to lower serum uric acid levels. Probencid can be given to patients with decreased clearance of uric acid from the kidney. Patients must have documented decrease in urine uric acid and have a creatinine clearance >40 cc/min. Allopurinol can be used in patients who either have decreased clearance of uric acid or elevated synthesis of uric acid. 5. Identify this medication? Allopurinol * xanthine oxidase inhibitor * prevents production of uric acid * useful in both patients with increased synthesis and decreased clearance of uric acid * no 24 hour urine needed * can be used in renal failure * rarely associated with bone marrow suppression, hepatotoxicity, and hypersensitivity reactions 6. Identify this medication? Probenecid * uricosuric * decreases uric acid reabsorption at the proximal renal tubules * useful in patients with decreased renal clearance of uric acid * can only be used if creatinine clearance >40 cc/min * must have 24 hour urine for uric acid <800 mg/dl * can be used in renal failure * increased risk of renal stones 7. Identify two historical figures that suffered with Gout? Thomas Sydenham’s Benjamin Franklin Fill-in-the-Blank Section 8. Purines: Components of all human tissue that break down to form uric acid. Purines are also found in many foods in varying amounts. 9. Arthritis: Literally means joint inflammation. It is a general term for more than 100 conditions known as rheumatic diseases. These diseases affect not only the joints, but also other parts of the body, including important supporting structures, such as muscles, tendons, and ligaments, as well as some internal organs. 10. Uric acid: An organic substance that results from the breakdown of purines or waste products in the body. It is dissolved in the blood and passes through the kidneys into the urine, where it is eliminated. Most patients with gout have high levels of uric acid in their blood. If the concentration of uric acid in the tissues rises above normal levels, crystals can form in the joints and cause inflammation. 11. Uric acid crystals: Caused by high concentrations of uric acid. When uric acid crystals form in the blood, they can collect in connective tissue, joints, and kidneys. Some kidney stones are made of uric acid. 12. Joint: A junction where two bones meet. Most joints are composed of cartilage, joint space, fibrous capsule, synovium, and ligaments. 13. Rheumatic diseases: A general term that refers to more than 100 conditions that affect joints, muscles, bones, and other connective tissues. 14. Synovial fluid: A substance found around the joints that nourishes and lubricates them. 15. Tendons: Fibrous cords of tissue that connect muscle to bone. 16. Connective tissue: The supporting framework of the body and its internal organs. 17. Corticosteroids: Potent anti-inflammatory hormones that are made naturally in the body or synthetically for use as drugs. The most commonly prescribed corticosteroid is prednisone. 18. Joint space: The volume enclosed within the fibrous capsule. 19. Ligaments: Bands of cordlike tissue that connect bone to bone. 20. Nonsteroidal anti-inflammatory drugs (NSAID`s): A group of drugs, such as aspirin and aspirin-like drugs, used to reduce the inflammation that causes joint pain, stiffness, and swelling. 21. Cartilage: A tough, resilient tissue that covers and cushions the ends of the bones and absorbs shock. 22. Colchicine: A medicine used to treat gout. It may be given by mouth (orally) or injected directly into a vein (intravenously). 23. Gout: A type of arthritis caused by the body’s reaction to needle-like crystals that accumulate in joint spaces. This reaction causes inflammation and extreme pain in the affected joint, most commonly the big toe. The crystals are formed from uric acid. Gout is caused by either increased production of uric acid or failure of the body to eliminate uric acid. 24. Hyperuricemia: Increased amount of uric acid in the blood. 25. Inflammation: A characteristic reaction of tissues to injury or disease. It is marked by four signs: swelling, redness, heat, and pain. 26. Tophus (plural tophi): A hard deposit of crystalline uric acid that may appear as a lump just under the skin, particularly around the joints and at the rim of the ear. 27. Crystal-induced arthritis: An accumulation of crystalline material in various parts of the body, especially the joints. Gout and pseudogout are examples of crystal- induced arthritis. 28. Pseudogout: Similar to gout; however, the crystals in the synovial fluid are composed of calcium pyrophosphate dihydrate and not uric acid. As in gout, the crystals in the joint space cause an intense inflammatory reaction in the joint. True or False Statements 29. Gouty arthritis attacks can be precipitated by organic tissue becomes hardened by the deposition of lime salts in the tissues. A. True B. False 30. The most reliable diagnostic test for gout is the identification of crystals in joints, body fluids and tissues. A. True B. False 31. The treatment of an attack of gouty arthritis is the same treatment as hyperuricemia. A. True B. False 32. Painful gouty arthritis is caused by mineral deposits in joint tissue. A. True B. False 33. The tendency to develop gout and elevated blood uric acid level (hyperuricemia) is often inherited. A. True B. False 34. Gout and hyperuricemia can be promoted by obesity, weight gain, alcohol intake, high blood pressure, abnormal kidney function, and drugs. A. True B. False 35. Gout is condition characterized by characterized by attacks of pain, progressive ataxia, loss of reflexes, functional disorders of the bladder, larynx, and gastrointestinal system, and impotence an overload of uric acid in the body and recurring attacks of joint inflammation (arthritis). A. True B. False 36. Chronic gout can lead to deposits of hard lumps osteofibrous material through which the flexor tendons and the median nerve pass. A. True B. False 37. Gout has the unique distinction of being one of the most frequently recorded medical illnesses throughout history. It is often related to an inherited abnormality in the body's ability to process uric acid. A. True B. False 38. Uric acid is a breakdown product of purines, that are part of many foods we eat. A. True B. False 39. An abnormality in handling uric acid can cause attacks of painful arthritis (gout attack), kidney stones, and costal cartilages of the ribs, the nasal septum, in the external ear and lining the Eustachian tube. A. True B. False 40. On the other hand, some patients may only develop elevated blood uric acid levels (hyperuricemia) without having arthritis or kidney problems. A. True B. False 41. The term "gout" commonly is used to refer to the deposition of calcium in chronically inflamed tendon, esp. the tendons of the shoulder painful arthritis attacks. A. True B. False 42. Gouty arthritis is usually an extremely painful attack with a rapid onset of joint inflammation. A. True B. False 43. The joint inflammation is precipitated by deposits of uric acid crystals in the joint fluid (synovial fluid) and joint lining (synovial lining). Intense joint inflammation occurs as white blood cells engulf the uric acid crystals and release chemicals of inflammation, causing pain, heat, and redness of the joint tissues. A. True B. False 44. Patients can develop fever with the acute gout attacks. These painful attacks usually subside in hours to days, with or without medication. A. True B. False 45. In rare instances, a gout attack can last for years. A. True B. False 46. Most patients with gout will experience repeated attacks of arthritis over the years. A. True B. False 47. Approximately one million people in the United States suffer from attacks of gout. A. True B. False 48. Gout is nine times more common in men than in women. A. True B. False 49. Gout predominantly attacks males after puberty, with a peak age of 50. In women, gout attacks usually occur before menopause. A. True B. False 50. While an elevated blood level of uric acid (hyperuricemia) may indicate an increased risk of gout, the relationship between hyperuricemia and gout is unclear. All patients with hyperuricemia will surely develop gout, while some patients with repeated gout attacks have normal or low blood uric acid levels. A. True B. False Final Assignment Write a complete 5 day diet for a 40 year old male that has gout. This patient has eaten mostly Mexican food and pizza most of his life. Lots of cheese and grease. Plan each meal in detail.