So with that, let's have
a few review questions.
I'll ask a question, feel free to pause the
slides and then come up with the answer yourself
before looking to see what our answer is.
So all of the following can contribute
to uric acid crystal formation except:
So the answer to this question,
think again about the great toe
and a patient at around
4 or 5 in the morning.
So they're gonna have a low pH, somewhat more
acidic blood, and therefore more acidic synovial fluid
Elevated temperature doesn't sound right.
People tend to be cooler at night so
that's probably gonna be our answer.
Uric acid concentration.
If you get dehydrated, your uric acid
concentration goes up in the synovial fluid
so that's gonna contribute
to uric acid crystal formation.
The presence of arthritis, we didn't talk much about
that but in the great toe, there's arthritis there
and each little defect in the articular cartilage serves
as a nidus for crystal formation and crystal growth.
So the presence of arthritis will
contribute to uric acid crystal formation.
And then dehydration, like I said.
so the answer in this case is elevated
temperature because it actually low temperatures
that's gonna lead to uric
acid crystal formation.
Second question, what are some of the differences
that you can recall between gout and pseudogout?
So the main differences here is that
there are different kinds of crystals.
Uric Acid crystals versus Calcium
Pyrophosphate deposition in the tissues.
Some of the risk factors are different.
You're thinking about
hyperparathyroidism, and excess iron
or hypomagnesemia or
phypophosphatemia for pseudogout
whereas you went through a whole
barrage of things that contribute to gout
that ultimately include increased purine metabolism or
purine production versus decreased purine excretion.
The other difference really come
down to the long-term management.
While both of them can be managed
with anti-inflammatory medications,
Gout you have some medications
which can decrease purine synthesis
like Allopurinol and you
have uricosuric agents
Whereas with Pseudogout you don't
have those things in your armamentarium.
So you're kind of stuck just using Colchicine as
a medication to try and suppress future flares
Next question, all of the following
are risk factors for gout except:
So we know a high protein diet is, that's
why it was called the "disease of kings".
That's one of the factors that we
know contributes to the fact that women
are less likely to develop gout than men.
so that's not really a risk
factor in fact it prevents gout.
So I'm pretty sure that's
gonna be our answer.
CKD - clog in the drain, you can't
get the uric acid out of your body.
HIV - by virtue of being a chronic inflammatory
disease contributes to increased turnover of cells
and therefore increased purine production.
And then diuretics, which unfortunately
inhibit the excretion of uric acid.
So our answer in this
case is clearly estrogen
because it promotes uric acid
excretion rather than prevents it.
And with that, I think we're done.