physiotherapy management of gout

1. SHRUTI
PUROHIT
FINAL YEAR

2.  Defination
 Pathogenesis
 Stages Of Gout
 Risk Factors
 Clinical Features
 Differential Diagnosis
 Invetigation
 Treatment

3.  A Metabolic Disease Characterised By Recurrent
Attack Of Acute Inflammatory Arthritis Caused By
Elevated Levels Of Uric Acid In The Blood.
(Hyperuricemia)
 Most Common Rheumatic Disease Of Adulthood.
 The Uric Acid Crystallizes & Deposits In Joints,
Tendons, & Surrounding Tissues As Tophi.
 Podagra Is A Painful Condition Of The Big Toe
Caused By Gout.
 Mainly Affect Big Toe, Also Affects Knees, Ankle,
Wrists, Fingers, Elbow, Toes Of Feet.

5.  2/3 of urate formed each day is excreted
by the kidneys & 1/3 from GI tract.
 Normal adult excrete 500-700mg of uric
acid/day.
 The Purine That A Person Eats & Also
Produced Naturally In Body, Are Metabolized
By The Body.
 Liver Is The Major Site Which Breaks Down The
Purines & Produces A Waste Product Called
Uric Acid.

6.  The Uric Acid Is Released Into The
Bloodstream & Eventually Filtered By The
Kidneys & Excreted In The Urine.
 If Too Much Uric Acid Builds Up Can Form Into
Crystals That Deposit In Your Jts. & Cause
Pain & Inflammation.

8.  Elevated Uric Acid Can Occur From Over
Production Or Under Excretion Of Uric Acid
 Over Production: (PRIMARY GOUT) 10-20%
• Less Common
• Genetic Abnormalities In Enzymes Related
Purine Metabolism
• ↓ Hypoxanthine-guanine Phosphorebosyl
Transferase(hgprt)
• ↑ Phosophoribosyl Pyrophosphate
Synthetase(prpp)

9.  Under Excretion: (SECONDARY
GOUT) 80-90%
• More Common
• ↓ GFR
• Decline In Urinary Excretion Of Uric Acid
 Can Determine By Measuring Urine Uric Acid
• >600mg/24hr Over Production
• <600mg/24hr Under Excretion

10. 4 stages:
 Asymptomatic
Hyperuricemia
 Acute Gout
 Intercritical Gout
 Chronic Tophaceous
Gout

11.  Serum Uate Abnormally High Without
Sign & Symptoms.
 Male > 7mg/Dl
 Female > 6mg/D
 Not Life Threatening & Readily
Treatable.
 Routine Prophylactic Rx Is Not
Required.

12.  The Intervals Between Attacks Of
Gouty Arthritis Are Reffered To As
Intercritical Periods.
 Intercritical Gout Simply Has Gout That
Has Caused Attacks Of Inflammation
In A Jts. In The Past But It Is Not Active
At The Time Evaluating The Pt.

13.  Acute, Self Limiting, Monoarticular
 Painful, Red, Hot, Swollen Accompained By
Fever, Raised ESR
 Usually Resolved Within 2 Weeks If Untreated.
But Recurrent Attacks Are Followed By
Progressive Cartilage & Bone Erosion,
Deposition Of Tophi, Secondary OA, &
Disability Associated With Permanent Restriction
Of Jt. Fun.
 May Occur Even If Serum Urate Is Normal
 Ll>Ul
 Also Present As Tenocynovitis, Bursitis, Cellulitis

14.  Polyarticular Arthritis + Tophi Formation.
 Articular Topheceous Gout May Results In
Destructive Arthropathy & Secondary OA.
 Serum Urate Level > 7mg/Dl.
 Disease Onset At Younger Age ≤ 40yrs.
 Sites Of Tophi:
 Digits Of Hands & Feet
 Helix Of Ear
 Bursa Around Elbow & Knee
 Achilles Tendon

15. o age (>35yr)
o sex (m>f=3:1)
o obessity
o high blood pressure
o injury
o recent surgery
o foods / drinks
o medications(diuretics, levo-dopa,
salicylates, nicotinic acid, cyclosporine)
o genetics (SLC2A9 , SLC22A12, ABCG2)
o medical
conditions(hypothyrodism, dm, pso-
riasis, heart failure, renal transplant, chronic
renal insufficiency, coronary heart disease)
o high protein diet
o life style

16. o Sever Pain At Joint
o Redness & Inflammation
o Fever
o Less Flexibility
o Nodules
o Itchy & Peeling Skin Later

17. Pseudogout (Deposition Of Calcium
Pyrophosphate Dyhydrate)
Septic Arthritis
Rheumatoid Arthritis
Trauma
Psoriatic Arthritis
Bursitis, Cellulitis, Tenosynovitis

18. Lab. Diagnosis
• Evidence Of Monosodium Urate Crystals By Jt.
Aspiration For Definitive Diagnosis
Synovial Fluid Analysis- Arthrocentesis
• Blood Test- Check Serum Uric Acid Level
• Urine Test
Most Uric Acid Disolves In Blood & Travels To The Kidneys, Where It
Passes Out In Urine.
If Body Produces Too Much Uric Acid Or Dosen’t Remove Enough Of
It, Person Can Get Sick

20.  REDIOGRAPHIC DIAGNOSIS

21.  PHARMECOLOGICAL
Rx
• NSAIDs
• Colchicine
• Corticosteroids
• Uricosurics
• Allopurinol
• Xanthine Oxidase
 Other
• Wt.Loss
• Exercise
• Diet(purine Contain
Diet ×)
 Surgical
• Removal Of Tophi
• Joint Fusion
• Joint Replacement

23. 
PHYSIOTHERAPY
 Pain control
 Barce
 Cryotherapy
 Ultrasound(1MHZ,1-
2W/Cm², 3-5min)
TREATMENT
 Rom
 Strenghtening
Ex.

25.  A Seronegative Arthritis Found In Pts. With
Psoriasis.
 It Is A Chronic Disease Charecterized By A
Form Of Inflammation Of The Skin & Jts.
 Classified With Hla-b27 Genetic Factor
Associated Spondyloarthritis.
 Immunologic Factor & Environmental Factor
Also Progress The Disease.
 Males & Femaes Are Equally Affected
 Peak Age Of Onset Between 30-55yrs.

26.  Family history.
 trauma, viral, bacterial
infection.
Signs & symptoms
 Painful,Tendor,Swolloen Jts.
 Hot red jts.-knee, ankle, feet
 Fatigue, morning stiffness
 Pitted nails, LBP

27.  Gouty Arthritis
 Ankylosing Spondyosis
 Rheumatoid Arthritis
INVESTIGATIONS
 Not Specific Diagnostic Test.
 Elevation Of Esr.
 Base On Clinical & Rdiological Basis.

28. New Bone Formation In Distal Jts.
 Lysis Of Terminal Phalanges.
“ Pencil In Cup” Like Appearance.

29.  Nsaids
 Corticosteroids
 DMARDS- Methotrexate,cyclosporine
 Coordinate B/W Rheumatology &
Dermatology

30.  Modalities- Heat, Cold
 Orthotics
 Active & Passive Exercise
 Streatching
 Strengthening