27. What you have to do for hyperuricemic patients :
Transplanted ?
28.
29. What you have to do for hyperuricemic patients :
Anuria ?
30.
31. What you have to do for hyperuricemic patients :
Lysis Syndrome ?
32. Olecranon bursitis secondary to gout in a 50-year-old man.
(a) Transverse US image shows a complex hypoechoic fluid collection ( * ) with
synovial thickening (arrowheads) and cortical irregularity with hyperechoic
foci (arrows), which are consistent with osseous erosions and crystalline
deposition from gout.
b) Color Doppler image shows hyperemic synovium. * = complex hypoechoic fluid
collection, arrows = osseous erosions and crystalline de position from gout.
33. What you have to do for hyperuricemic patients :
Excess urinary excretion ?
36. Gout in the Wrist
Gout is a type of arthritis that is caused by excess uric acid build-up in the joints. Most gout patients report swelling and discomfort in the foot or big toe. However, gout-
related wrist pain can be a sign of polyarticular gout, or gout that affects multiple joints. Since this is less common, gout in the wrist can be difficult to recognize. If you
have a history of gout and are also suffering from wrist pain, you should ask your physician about it during your next visit.
Gout that is isolated to the wrist is extremely rare, but pseudogout can affect large joints
37. What you have to do for hyperuricemic > 13 mg / dl ?
38.
39. What you have to do for hyperuricemic > 20 mg / dl ?
40. Gouty
Panniculitis
E : Severe ulnar
deformity along with
multiple gouty tophi in
both hands.
A : Presence of 2 tophi in the nose dorsum; aspiration of the
lesion confirmed birefringent crystals.
B : two gouty tophi in the
ear.
C and D :
Gouty Tophi in forearms,
elbows, and feet, some of
them ulcerated. tophi in
legs and pretibial area.
41. What you have to do for hyperuricemic > 80 mg / dl ?
44. A uric acid deposit in the Prepatellar Bursa of the
right knee in a patient with tophaceous gout.
The patient also has a large effusion in the
suprapatellar pouch.
46. A , Dorsal digits of the hand of a patient with tophaceous gout.
The involvement of the third distal interphalangeal joint has an appearance
similar to inflammatory osteoarthritis or psoriatic arthritis in the appropriate clinical setting.
B, Palmar view of the same hand revealing obvious โstuddingโ of uric acid deposits.
54. Fusiform tophus of the Achilles tendon above the insertion on the calcaneus
55. A Tophus in the helix of the ear
in a patient with Chronic
Gout
56.
57. Is it right to give Prophylactic Colchicine without controlling
Hyperuricemia ?
58.
59. Digital images showing complete resolution of tophi in two patients who
received pegloticase biweekly.
A, Baseline tophus on the
medial aspect of the right third distal interphalangeal (DIP) joint in
patient 1.
B, Complete resolution of target tophus at week 13 in patient 1.
Note also the reduction in the area of a large tophus on the 3rd PIP
C, Baseline tophi on the right thumb; on the 2md, 3rd, & 4th DIP
joints with ulcerations; and on the 5th PIT joint of patient 2 after 6
months of treatment with placebo in randomized
controlled trials.
D, Complete resolution of target tophi on four digits in patient 2 after
25 weeks of treatment with twice-monthly pegloticase in an open-label
extension study.
(From Baraf HS, Becker MA, Gutierrez-Urena SR, et al: Tophus burden reduction with
burden reduction with pegloticase: results from phase 3 randomized
randomized
trials and open-label extension in patients with chronic gout refractory to conventional therapy.
refractory to conventional therapy. Arthritis Res Ther 15:R137, 2013.)
60. What are the Diseases should be treated before ULT ?
What are the Medications should be optimized before ULT ?
What are the Foods should be Reduced before ULT ?
What are the Foods should be Restricted OR avoided ?
What are Foods should be Encouraged ?
What is the disease that causing
Overproduction & Underexcretion of urates ?
61. Eltroxin may help ULT ?
Vitamin-D analogue may help
Uricosurics for Sarcoidosis but not Psoriasis ( XOIs )
Hyperuricemia may be Fatal for pregnant with Toxemia
To avoid low dose of aspirin : 350 mg weekly
Dehydration causing Hyperuricemia &
Fasting triggering acute attack of Gout ?
What is wonderful :
62. Is gout still disease of the kings & king of the diseases ?
90. What you have to do for hyperuricemic patients :
Transplanted ?
91.
92. What you have to do for hyperuricemic patients :
Anuria ?
93.
94. What you have to do for hyperuricemic patients :
Lysis Syndrome ?
95. Olecranon bursitis secondary to gout in a 50-year-old man.
(a) Transverse US image shows a complex hypoechoic fluid collection ( * ) with
synovial thickening (arrowheads) and cortical irregularity with hyperechoic
foci (arrows), which are consistent with osseous erosions and crystalline
deposition from gout.
b) Color Doppler image shows hyperemic synovium. * = complex hypoechoic fluid
collection, arrows = osseous erosions and crystalline de position from gout.
96. What you have to do for hyperuricemic patients :
Excess urinary excretion ?
99. Gout in the Wrist
Gout is a type of arthritis that is caused by excess uric acid build-up in the joints. Most gout patients report swelling and discomfort in the foot or big toe. However, gout-
related wrist pain can be a sign of polyarticular gout, or gout that affects multiple joints. Since this is less common, gout in the wrist can be difficult to recognize. If you
have a history of gout and are also suffering from wrist pain, you should ask your physician about it during your next visit.
Gout that is isolated to the wrist is extremely rare, but pseudogout can affect large joints
100. What you have to do for hyperuricemic > 13 mg / dl ?
101.
102. What you have to do for hyperuricemic > 20 mg / dl ?
103. Gouty
Panniculitis
E : Severe ulnar
deformity along with
multiple gouty tophi in
both hands.
A : Presence of 2 tophi in the nose dorsum; aspiration of the
lesion confirmed birefringent crystals.
B : two gouty tophi in the
ear.
C and D :
Gouty Tophi in forearms,
elbows, and feet, some of
them ulcerated. tophi in
legs and pretibial area.
104. What you have to do for hyperuricemic > 80 mg / dl ?
107. A uric acid deposit in the Prepatellar Bursa of the
right knee in a patient with tophaceous gout.
The patient also has a large effusion in the
suprapatellar pouch.
109. A , Dorsal digits of the hand of a patient with tophaceous gout.
The involvement of the third distal interphalangeal joint has an appearance
similar to inflammatory osteoarthritis or psoriatic arthritis in the appropriate clinical setting.
B, Palmar view of the same hand revealing obvious โstuddingโ of uric acid deposits.
117. Fusiform tophus of the Achilles tendon above the insertion on the calcaneus
118. A Tophus in the helix of the ear
in a patient with Chronic
Gout
119.
120. Is it right to give Prophylactic Colchicine without controlling
Hyperuricemia ?
121.
122. Digital images showing complete resolution of tophi in two patients who
received pegloticase biweekly.
A, Baseline tophus on the
medial aspect of the right third distal interphalangeal (DIP) joint in
patient 1.
B, Complete resolution of target tophus at week 13 in patient 1.
Note also the reduction in the area of a large tophus on the 3rd PIP
C, Baseline tophi on the right thumb; on the 2md, 3rd, & 4th DIP
joints with ulcerations; and on the 5th PIT joint of patient 2 after 6
months of treatment with placebo in randomized
controlled trials.
D, Complete resolution of target tophi on four digits in patient 2 after
25 weeks of treatment with twice-monthly pegloticase in an open-label
extension study.
(From Baraf HS, Becker MA, Gutierrez-Urena SR, et al: Tophus burden reduction with
burden reduction with pegloticase: results from phase 3 randomized
randomized
trials and open-label extension in patients with chronic gout refractory to conventional therapy.
refractory to conventional therapy. Arthritis Res Ther 15:R137, 2013.)
123. What are the Diseases should be treated before ULT ?
What are the Medications should be optimized before ULT ?
What are the Foods should be Reduced before ULT ?
What are the Foods should be Restricted OR avoided ?
What are Foods should be Encouraged ?
What is the disease that causing
Overproduction & Underexcretion of urates ?
124. Eltroxin may help ULT ?
Vitamin-D analogue may help
Uricosurics for Sarcoidosis but not Psoriasis ( XOIs )
Hyperuricemia may be Fatal for pregnant with Toxemia
To avoid low dose of aspirin : 350 mg weekly
Dehydration causing Hyperuricemia &
Fasting triggering acute attack of Gout ?
What is wonderful :
125. Is gout still disease of the kings & king of the diseases ?
