Gout is a metabolic disorder of purine metabolism, characterized by intermittent attacks of acute pain, swelling, and inflammation. It always preceded by Hyperuricaemia(6.0mg/dl) Hyperuricemia due to an excessive amount of uric acid production or decreased excretion. Gout is mainly classified into the following categories: Acute Gout Chronic Gout Pseudogout

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Gout
Presented by Raju Budha Magar
And Rubi Shrestha

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Table of content
 Introduction
 Sign and symptoms
 Aetiology
 Pathophysiology
 Diagnosis
 Treatments

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Introduction
 Metabolic disorder of purine metabolism
 Characteristics by acute pain and inflammation.
 Hyperuricemia (6.0m/dl)
 Excessive uric acid production or decrease excretion.
 Main types are:
• Acute gout
• Chronic gout
• Pseudo-gout

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Sign and symptoms
 Podagra
 Arthritis in other site
 polyarticular arthritis
 Monoarticular involvement
 Involvement of a single (most common) or multiple joints
 Signs of inflammation

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Sign and symptoms
 Fever
 Migratory polyarthritis
 Tophi in soft tissues
 Eye involvement

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Aetiology
 Gout develops in the setting of excessive stores of uric acid in
the form of monosodium urate.
 Uric acid is an end-stage by-product of purine metabolism.
 Hypertension
 Diabetes mellitus
 Renal insufficiency

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Aetiology
 Hyper-triglyceridemia
 Hypercholesterolemia
 Obesity
 Anaemia

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Diagnosis
 Joint aspiration and synovial fluid analysis
 Serum uric acid measurement
 24-hour urinary uric acid evaluation
 Blood studies
 Plain radiographs
 Ultra-sonography

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Pathophysiology

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Management
1.Non-pharmacological management:
 Avoidance or restricted consumption of high-purine foods
 Avoidance of excess ingestion of alcoholic drinks, particularly beer
 Avoidance of sodas and other beverages or foods sweetened with
high-fructose corn syrup
 Limited use of naturally sweet fruit juices, table sugar, and
sweetened beverages and desserts, as well as table salt

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Management
 Maintenance of a high level of hydration with water (≥8 glasses
of liquids daily)
 A low-cholesterol, low-fat diet, if such a diet is otherwise
appropriate for the patient
 Weight reduction in patients who are obese

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Management
Pharmacological management of gout:
Gout is managed in the following 3 stages:
 Treating the acute attack
 Providing prophylaxis to prevent acute flares
 Lowering excess stores of urate to prevent flares of gouty
arthritis and to prevent tissue deposition of urate crystals(chronic
gout )

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Management of acute gout
1.Non-steroidal anti-inflammatory drugs (NSAIDs), such as
Indomethacin
2.Corticosteroids
3.Colchicine(1.2mg loading dose & followed by .6mg I hour later )
4.Adrenocorticotropic hormone (ACTH)
e.g. Predinsolone(200mg/day for one week for one month)

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Management of acute gout
5.Combinations of drugs
 colchicine +NSAIDs,
 oral corticosteroids+ colchicine,
 intra-articular steroids+ colchicine or NSAIDs

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Management of chronic gout
1. Uricosuric drugs
 Probenecid(250 mg BID for one week)
 sulfinpyrazone(
2. Uric acid synthesis inhibitors
 allopurinol(100mg/day and increase to 200 -300 mg /day )
 Febuxostat(initial 40mg and may increase to 80mg )
3. Colchicine or low-dose NSAIDs
4. Low-dose prednisone

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Thank you !!

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