NURS 6501 Week 7 Knowledge Check: Neurological and Musculoskeletal Disorders Sample Approach Explain the Pathophysiology of Gout

NURS 6501 Week 7 Knowledge Check: Neurological and Musculoskeletal Disorders Sample Approach Explain the Pathophysiology of Gout

NURS 6501 Week 7 Knowledge Check: Neurological and Musculoskeletal Disorders Sample Approach

Explain the Pathophysiology of Gout

Gout refers to chronic inflammatory arthritis designated by the accumulation of monosodium urate monohydrate crystals in tissues (Narang & Dalbeth, 2020). Approximately 4% of the world’s population is affected by gout (Narang & Dalbeth, 2020). Gout is considered a complex metabolic disorder whose pathophysiology encompasses an interplay of modifiable and non-modifiable factors. Modifiable factors include obesity, hypertension, hyperlipidemia, diet, alcohol, medications, diabetes mellitus, and cardiovascular disease (Narang & Dalbeth, 2020).

Meanwhile, non-modifiable factors include male gender, advanced age, family history, and ethnicity. Elevated urate levels are necessary for the development of gout. This may result from overproduction due to alterations in purine synthesis and degradation pathways, as well as renal underexcretion of urate. Elevated urate and uric acid levels result in supersaturation and precipitation of monosodium urate monohydrate crystals in tissues, particularly the synovium, kidney, bone, ligament, skin, and tendon. This process may be asymptomatic.

In some individuals, however, the deposition of these crystals induces an acute inflammatory response mediated by innate immune system activation (Narang & Dalbeth, 2020). Additionally, some patients develop advanced gout characterized by structural joint damage mediated by the direct effects of monosodium urate monohydrate crystals on tissues, as well as indirect effects of joint inflammation.

Explain why a patient with gout is more likely to develop renal calculi.

Patients with gout typically have elevated urate and uric acid in their blood (McCance & Huether, 2019). Uric acid is a weak organic acid and hence exists in the non-ionized form in acidic states, such as in urine. The non-ionized form is less soluble and, therefore, prone to precipitation and crystallization, resulting in the formation of calculi. Individuals with gout tend to develop renal calculi since their increased pool of urate stresses the kidney, which is tasked with urate excretion.

Urine is acidic. A low urinary pH contributes to uric acid calculi formation by altering the dissolution of uric acid, leading to its precipitation (Ma et al., 2018). Similarly, patients with gout have altered urate transporters in the proximal tubule, resulting in diminished fractional excretion of uric acid, hence predisposing to stone formation (Ma et al., 2018). Finally, individuals with gout have low levels of crystallization inhibitors such as glycosaminoglycans, further predisposing them to stone formation.

Discuss what is osteoporosis and how does it develop pathologically? 

Osteoporosis is a chronic metabolic bone disease characterized by increased bone fragility (McCance & Huether, 2019). Approximately 200 million people worldwide suffer from osteoporosis (Föger-Samwald et al., 2020). Osteoporosis commonly affects females and its incidence increases with age. Osteoporosis is a chronic progressive condition and can be primary or secondary. Primary osteoporosis is an outcome of aging and diminished sex hormones, while secondary osteoporosis results from other disease processes.

Normally, bone formation and bone resorption are in a fair balance. Consequently, conditions that increase bone resorption or decrease bone resorption interfere with bone microarchitecture, leading to decreased skeletal mass and increased bone fragility. Several factors, including environmental and genetic, have been implicated in the development of osteoporosis. For instance, increasing age, low body mass index, use of corticosteroids, family history of osteoporosis, decreased levels of physical activity, early menopause, smoking, female gender, and alcohol intake (McCance & Huether, 2019).

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