3. Acute and chronic arthritis
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Acute arthritis is the most frequent early clinical
manifestation of MSU gout.
Usually only one joint is affected initially
Polyarticular acute gout is also seen in male
hypertensive patients with ethanol abuse as well as
in postmenopausal women.
6. Epidemiology
Prevalence of hyperuricaemia 5%
Prevalence of Gout 0.2%
M:F ratio 10:1
Hyperuricaemia is defined as >2 SD from mean 420
μmol in males and 360 μmol/l in females.
11. Cause of hyperuricaemia
90% have decreased excretion
10% have increased production
1% have in born error of metabolism like HGPRT def
or PRPP overactivity
12. Uric acid synthesis
Uric acid is the last step in purine breakdown
Conversion of hypoxnthine to xanthine and xanthine
to Uric acid is catalysed by Xanthine Oxidase
15. Combined Mechanisms
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Alcohol intake promotes hyperuricemia:
Fast hepatic breakdown of ATP and increases
urate production.
Can induce hyperlacticacidemia, and inhibition of
uric acid secretion.
The higher purine content in some alcoholic beverages
such as beer may also be a factor.
25. Acute Gout
Sudden onset of severe agonizing pain, swelling of
1st
MTP joint
Too painful to touch or move
Precipitated by food, exercise, alcohol or diuretic
Usually recovers in 7 days
Typically associated with desquamation of overlying
skin
28. Treatment
High Dose NSAIDs
Rapid response
Naproxen 750 mg initially then 500mg bid
Diclofenac 75-100 mg intially then 50 mg bid or tid
Indomemethacin 75 mg initially the 50 mg bid or qid
29. Alternative treatments
Colchisine 1000mg initially then 500mg bid to qid
((DIARRHOEA))
Corticosteroids ((intramuscular or intra articular))–
depot methylpredisolone
30. Reduction of Serum Urate
Dietary advice
Weight reduction
Advice on alcohol consumption
32. A word about Allopurinol
Relatively safe drug
Can cause rashes and rarely bone marrow
suppression
Use only in frequent and severe attacks when diet
and life style modification has failed to prevent
acute attacks
DO NOT USE within ONE MONTH of acute attack
Started under cover of NSAIDs
35. Chronic tophaceous gout
Sodium urate forms white smooth deposits in skin
and around joints
Typical sites
Ear lobes, fingers and Achilles tendon
Can ulcerate
Causes bone destruction (punched out) bone cysts
on x-rays
Often accom. by renal impairmrnt
36.
37.
38.
39. Psudogout ((Pyrophosphate athropathy))
1. Another form of crystal arthropathy
2. Can resemble acute gout
3. Affects elderly women
4. Usually affects knees and wrists
5. Caused by deposition of Calcium pyrophosphate
crystals