1. Describe the pathogenesis of hyperuricemia and gout Goup C1 Group C1

HYPERURICEMIA Plasma/serum urate concentration >408 mol/L (6.8 mg/dL) Present in between 2.0 and 13.2% of ambulatory adults, and is more frequent in hospitalized individuals Causes increased production of uric acid decreased excretion of uric acid combination of the two processes Harrison’s Principles of Internal Medicine, 17 th edition Group C1

Pathophysiology decreased excretion (underexcretors) increased production (overproducers) combination of these two mechanisms. Underexcretion accounts for most causes of hyperuricemia Group C1

Pathogenesis of Hyperuricemia and Gout Group C1

2. Outline the risk factors for gout and hyperuricemia Group C1

Risk factors of Gout Obesity Alcohol use Family Hx History of Kidney Disease Diet Others – Medications (Aspirin, Pyrazinamide, Ethambutol) – Lead exposure – Hypertension – Diabetes – Hyperlipidemia – Arterioslcerosis Group C1

Obesity - Uric acid production increases and acid elimination decreases in people with high body mass indices (BMI). - extra weight puts more pressure on body joints. - Obese people tend to eat high purine foods, such as red meat or seafood. Group C1

Alcohol -Increased alcohol(beer) consumption doubles the likelihood of getting gout because of alcohol's high purine count. Group C1

Family History -history of weak organs (such as kidneys) in the family, or recipes containing high amounts of purines passing down from generation to generation. Group C1

Kidney Disease -Kidneys flush out wastes from the body, including uric acid. -People with kidney disease are more vulnerable to high uric acid levels in their bloodstream, because their kidneys can't remove enough of the acid. The acid crystallizes in the joints and causes pain. Group C1

3. Enumerate the stages of gout Group C1

STAGES OF GOUT Gout can progress through four stages: 1.Asymptomatic hyperuricemia - In this stage, a person has elevated levels of uric acid in the blood but no other symptoms. -A person in this stage does not usually require treatment. 2. Acute gout/acute gouty arthritis - In this stage, hyperuricemia has caused the deposit of uric acid crystals in joint spaces. This leads to a sudden onset of intense pain and swelling in the joints, which also may be warm and very tender. -An acute attack commonly occurs at night and can be triggered by stressful events, alcohol or drugs, or the presence of another illness. -Early attacks usually subside within 3 to 10 days, even without treatment, and the next attack may not occur for months or even years. Over time, however, attacks can last longer and occur more frequently. Group C1

STAGES OF GOUT 3. Interval/intercritical gout -This is the period between acute attacks. In this stage, a person does not have any symptoms and has normal joint function. 4. Chronic tophaceous gout -This is the most disabling stage of gout and usually develops over a long period, such as 10 years. - In this stage, the disease has caused permanent damage to the affected joints and sometimes to the kidneys. With proper treatment, most people with gout don't progress to this stage. Group C1

4. Outline at least 4 types of skin and soft tissue infections (including cellulitis); for each type indicate most common etiologic organism/s Group C1

Skin and Soft tissue infections Skin and soft tissue infectionEtiologic organism/s CellulitisStaphylococcus spp., Streptococcus spp., various other bacteria ErysipelasStreptococcus pyogenes FurunculosisStaphylococcus aureus Acne vulgarisPropionibacterium acnes Harrison’s Principles of Internal Medicine, 17 th edition, 2008 Group C1

5. Give possible explanation/s for absence of fever despite the presence of infection and leucocytosis Group C1

Possible explanation: Gout is an inflammatory type of arthritis. Due to non-compliance to medication (with a 5 year history of the disease), the patient may have progressed into the chronic type of the disease. Fever may not be present during a chronic type inflammation/ infection, but there could be increased WBC, ESR. Group C1