Porella : features, morphology, anatomy, reproduction etc.
GOUT
1. GOUT
THE DISEASE OF KINGS
SUPRAJA M KODANCH
GUIDED BY,
BC120135
DR. PAVITHRA.K
II YEAR, III SEM
2. INDEX:
• Introduction to Gout
• History of Gout
• Etiology
• Clinical manifestation
• Genetics
• Classification of Gout
• Stages of Gout
• Diagnosis
• Treatment
• Preventive measures
• Overview of Gout
• Bibliography
3. GOUT
INTRODUCTION :
• The term Gout is derived from the Latin
word ‘Gutta’, meaning ‘a drop’ as it
appears like small drop or bubble on joints.
• Gout describes a disease spectrum
preceded by hyperuricemia, recurrent
attacks of acute arthritis associated with
elevated levels of monosodium urate
crystals in leucocytes found in synovial
fluid, plasma and also in tissues.
• Normal range of uric acid in human
serum;
Adult male : 4.0 – 8.5 mg/dl
Adult female : 3.0 – 7.5 mg/dl.
4. • Gout was first identified by - Egyptians
• The probable origin in previous centuries,
when wine was often contaminated with
lead during its manufacturing resulted in
chronic lead poisoning, which, decreases
the kidney’s ability to excrete uric acid.
• Gout is popularly known as “Disease of
Kings”, because of the lavish diet and
alcoholic consumption of the wealthy
kings.
HISTORY :
5. ETIOLOGY :
1. Metabolic disorder caused due to deficiency and
hyperactivity of enzymes.
• Increased PRPP synthetase activity.
• HGPRT enzyme deficiency.
• Glucose -6- phosphatase deficiency.
2. Alcoholism
3. Intake of high concentration of fructose.
4. Mutation in urate transporter protein coding genes such as;
SLC2A9, SLC22A12, ABCG2, GLUT9a etc,.
12. CLINICAL MANIFESTATION:
1) The joints become inflammed, very
much painful, and arthritic, owing to
the abnormal deposition of sodium
urate crystals, most often in big toe.
2) Aggregates of uric acid crystals
results in a lump called Tophi.
Antonie Van Leeuwenhoek - First to
describe the appearance of the
crystals from a gouty tophus.
3) Sodium urate precipitate in the kidney
and ureter as stones, resulting in renal
damage and urinary tract obstruction.
4) Gout is thus referred as 'the
unwalkable disease'.
TOPHI
13. GENETICS :
• Gout caused due to the deficiency of Glucose – 6- phosphatase
enzyme (Chromosome 17 at band q21) : Autosomal recessive trait.
• Gout caused due to the deficiency of HGPRT enzyme and
hyperactivity of PRPP synthetase enzyme : X – linked recessive
trait.
14. CLASSIFICATION OF GOUT:
1. Primary gout:
a) Basic metabolic defect is unknown.
b) Increased production of uric acid due to excess dietary purines.
c) Rare enzyme mutation defects (HGPRT deficiency) and hyperactivity of
PRPP synthetase.
d) Undersecretion of uric acid from a defect in renal excretion.
2. Secondary gout:
a) Associated with increased nucleic acid turnover.
b) Decreased renal function or drug induced.
c) Deficiency of glucose- 6 –phosphatase.
d) Myeloid proliferative disorders, psoriasis, exercise and uncontrolled
diabetes.
15. STAGES OF GOUT:
1. Acute gout
• Sudden onset of painful arthritis and
pain worsens progressively.
• Generally attacks one or few joints
• Most common site of initial attack -
metatarsophalangeal joint.
• Other sites - ankle, heel, knee, wrist,
elbow and fingers.
2. Chronic gout
• Frequency of attacks increases,
continuous deposit leads to damage
joints and chronic pain.
• Patients may develop large
subacutenous tophi in pinna of external
ear, eyelids, nose, joints etc.
• Urate crystals in kidney leads renal
disease.
• Articular cartilage may get destroyed and
results in joint deformities.
Onset of symptoms
Tophi at multiple sites
16. DIAGNOSIS:
1) Physical
examination: Your provider
will examine the affected joint
to look for swelling, redness
and warmth.
2) Serological test : Primarily,
serum urate level is measured.
If it crosses the normal range,
it indicates hyperuricemia.
HIGH SERUM URATE DOES
NOT NECESSARILY MEAN
THE PATIENT HAS GOUT!
Physical examination by Physicians
Laboratory diagnosis
17. 3) X-rays scanning :
Appear normal in early
stages. Tophi appear as
eroded areas of bone .
4)Synovial fluid analysis :
Under polarized light
microscopy, sodium urate
crystals appears as needles
and rods shaped. This test is
regarded as ‘Gold standard’.
X- ray image
Sodium urate crystals under microscope
18. 5) Computed tomography :
This is a useful diagnostic tool for detecting diseases and injuries.
It uses a series of X-rays and a computer and produce a 3D image of soft
tissues and bones.
Images of CT scan
20. 2) Uricosuric drugs
Are relegated to second line treatment of patients with elevated
urate burden and tophaceous disease.
• a) Probenecid – Very effective drug that concentrates and promotes
urinary excretion of urates.
• b) Lesinurad – It is an inhibitor of renal transport proteins. It is given
in combination with allopurinol.
• c) Benzbromarone and Sulfinpyrazone are effective non-steroidal
anti-inflammatory drugs ( NSAID ).
21. 3) Colchicine
• Alkaloid from Colchium autumnale.
• Neither analgesic nor anti inflammatory,
but specific for gouty inflammation.
• It is only effective in prophylaxis of
acute gout.
• Colchicine binds to intracellular protein
‘Tubulin’ and causes depolymerisation
and disappearance of microtubules in
granulocytes & inhibit granulocyte
migration, so decreases phagocytic
activity and thereby reduces arthritic
inflammation in joints.
Colchium autumnale
Colchicine structure
22. PREVENTIVE MEASURES:
Do your best to limit the purines in your body, since these chemicals
can trigger uric acid buildup. Foods and drinks containing high
purine levels include:
• Alcohol.
• Red meat and organ meats (liver, for example).
• Shellfish.
• Gravy.
• Drinks and foods high in fructose (fruit sugar).
• Protein from animal sources. All protein from animal flesh can
potentially lead to elevated uric acid levels.
24. BIBLIOGRAPHY
• Clinical Biochemistry: Metabolic and Clinical aspects
Authors: William J. Marshall, Stephen K. Bangert
• Voet’s Principles of Biochemistry
Authors: Donald Voet, Judith G. Voet, Charllotte W. Pratt
• Harper’s illustrated Biochemistry
Authors: Victor W. Rodwell, David A. Bender, Peter J. Kennelly
• http://www.ncbi.nlm.nih.gov
• Images - Google resource
