Urate-lowering Therapy: Gout Pathophysiology and Disease Stages (Nursing)

00:01 In this video series, we're discussing urate lowering therapies for gout management.

00:06 Now this is an important topic because gout is one of the most common inflammatory arthropathies that affects approximately 4% of the U.S. adult population.

00:16 Now before we discuss the medications we use to treat gout, it's important that we understand the underlying pathophysiology.

00:23 Let's start with normal purine metabolism.

00:26 Purines are nitrogen-containing compounds that are essential components of our DNA, our RNA, and our energy-carrying molecules like ATP.

00:35 So purines can come from our diet or they can be synthesized in our bodies.

00:40 But when our cells break down, their DNA and RNA get metabolized and the purines eventually form uric acid as the end product of this metabolism.

00:50 Now the body eliminates uric acid through two pathways.

00:53 Approximately 70% goes out via the kidneys and another 30% goes out via the intestines.

01:00 Now though the kidneys filter uric acid from the blood, they actually reabsorb about 90% of what they initially filtered.

01:08 And even though despite this reabsorption, the kidneys still manage to eliminate about 70% of the body's total uric acid.

01:15 But in pathological states, we see hyperuricemia.

01:19 That means we have an elevated uric acid level.

01:22 We define that as a serum uric acid level greater than 6.8.

01:27 Now this can happen, this elevated uric acid level, for one of two main reasons.

01:32 Either the body produces too much uric acid or the kidneys don't excrete enough of it.

01:38 So when that blood becomes super saturated with uric acid, monosodium urate crystals form.

01:44 Ah ha! This becomes the problem.

01:47 You see, monosodium urate crystals, these guys are nasty.

01:51 They are needle-shaped crystals and they can deposit in the joints, your soft tissues, and the kidneys.

01:58 So when they're in the joints, these crystals trigger this intense inflammatory response when they're engulfed by neutrophils.

02:05 This is what leads to the classic symptoms of a gout attack.

02:08 Severe pain, swelling, redness, and warmth.

02:12 Now gout's typically going to progress through four stages.

02:15 There's the asymptomatic hyperuricemia, acute gouty arthritis, intercritical gout, and chronic tophaceous gout.

02:24 So let's take a look at those.

02:27 Asymptomatic hyperuricemia is just what it sounds like.

02:30 There's an elevated uric acid, but the client isn't experiencing symptoms yet.

02:35 It's acute gouty arthritis.

02:37 Now it's painful and they're having the inflammatory flares.

02:41 In intercritical gout, they're symptom-free for periods in between the attacks.

02:46 And finally, the fourth stage we're going to discuss, it's advanced disease, and it has visible TOFI, those uric crystal deposits, joint damage, and chronic pain.

02:56 That is what we're trying to avoid.

02:59 Your understanding of this process and the four stages helps explain why we target specific pathways with our medications.