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Physiology & Biochemistry · patient case with 2 questions

Patient with gout

Scenario: A patient with GOUT.

Question 1

Which metabolic component is involved in gout?

  1. Nucleic acids (purine metabolism)
  2. Amino acids
  3. Fatty acids
  4. Simple carbohydrates
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Correct answer: A. Nucleic acids (purine metabolism)

  • A. Correct. Gout results from disordered PURINE metabolism. Purines from nucleic acid breakdown are catabolised by xanthine oxidase to URIC ACID; when serum urate is high, monosodium urate crystals precipitate in joints producing acute inflammatory arthritis — classically the first metatarsophalangeal joint (podagra).
  • B. Amino acid disorders produce conditions such as phenylketonuria and homocystinuria, not gout.
  • C. Fatty acid and lipid disorders produce hyperlipidaemias and atherosclerosis.
  • D. Carbohydrate metabolism disorders include diabetes mellitus and the glycogen storage diseases.

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Question 2

Which medication is used for this condition?

  1. Metformin
  2. Levothyroxine
  3. Allopurinol
  4. Alendronate
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Correct answer: C. Allopurinol

  • A. Metformin is a biguanide for type 2 diabetes; it reduces hepatic gluconeogenesis and improves insulin sensitivity.
  • B. Levothyroxine is thyroid hormone replacement for hypothyroidism.
  • C. Correct. Allopurinol is a XANTHINE OXIDASE INHIBITOR — it blocks conversion of hypoxanthine and xanthine to uric acid, lowering serum urate for long-term prevention. Acute attacks are treated instead with NSAIDs, colchicine or corticosteroids.
  • D. Alendronate is a bisphosphonate for osteoporosis — clinically important in dentistry for MRONJ risk, but unrelated to gout.

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