Gout is an inflammatory arthritis primarily caused by hyperuricemia, leading to painful, swollen joints often beginning in the big toe. It can be classified into primary and secondary gout, with several risk factors such as obesity, genetics, and dietary choices influencing its onset. Management includes symptomatic treatment during attacks, medications to lower uric acid levels, and lifestyle changes to prevent future occurrences.

1. GOUT
PRESENTER: O. MALIYAMA

2. LEARNING OUTCOMES
• Define gout
• List types of gout
• Mention cause of gout
• State stages of gout
• State aggravating factors of gout
• List risk factors of gout
• Mention types of food which can predispose to gout
• triggers of gout attack
• List clinical manifestations of gout
• State diagnostic procedures of gout
• Explain management of gout

3. OVER VIEW OF GOUT
• Gout is a type of inflammatory arthritis that causes pain
and swelling in joints, usually last for a week or two, and
then resolve. Gout often begin in a big toe or a lower limb.
This happens when high levels of serum urate build up in
in the body, which can then form needle-shaped crystals
in and around the joint. This leads to inflammation and
arthritis of the joint. When the body makes too much
urate, or removes too little, urate levels build up in the
body. However, many people with high levels of serum
urate will not develop gout

4. DEFINITION
•Gout arises due to deposition of uric acid crystals within
joints
TYPES OF GOUT
1. Primary gout: Mostly it is due to inherited gout genes
2. Secondary gout: May be caused by the following: chronic kidney
disease, long-term use of medications that affect how ability of
kidneysin removing urate fromthe body

5. CAUSE
Cause of gout is an elevated uric acid level in the bloodstream,
known as hyperuricemia. This leads to the buildup of uric acid
crystals in tissues of the body
PARTS OF THE BODY INVOLVED
Joints
Bursae, cushion-like sacs between bones and other soft tissues.
Tendon sheaths, membranes that surround tendons.
Kidneys, because the high uric acid levels can lead to stones and
sometimes kidney damage
Ankles, knees, elbows, wrists and fingers

6. STAGES OF GOUT
Gout is a disease that can move through several stages namely:
• Hyperuricemia: when an individual has elevated levels of urate in
the blood. This leads to crystal formation in joint/s, but an
individual does not have symptoms
• Gout flares: when an individual has an attack of intense pain and
swelling in joint/s
• Interval or inter-critical gout: This is the time between gout
attacks

9. AGRAVATING FACTORS
Diuretics, which help the body eliminate excess fluid
Low-dose aspirin
Niacin (a vitamin), when taken in large amounts
Cyclosporine, which is an immunosuppressant for people who
have organ transplants and treats some autoimmune diseases

10. RISK FACTORS
Overweight or obesity
Congestive heart failure
Diabetes
Hypertension
Kidney disease
Blood cancer

11. RISK FACTORS CT…
Having a biological parent or grandparent who has
gout
Eating lots of animal proteins — especially animal
flesh, shellfish and foods that contain organ meat
Drinking alcohol regularly
On diuretic medication
On immunosuppressants medication

12. RISK FACTORS CT…
Family history
• Even though once kidneys can be completely healthy, sometimes
the genes inherited make it more likely that kidneys don’t flush
urate out as well as they should.
• This is the most common cause of primary gout, especially when
several family members are affected, such as parents or
grandparents.

13. RISK FACTORS CT…
Being overweight
Gout is much more common in people who are overweight. The
more overweight an individual is, the more urate the body produces.
This means that the body may produce more urate which makes
kidneys failing to cope. There fore being overweight also makes it
more likely that an individual may have:
high blood pressure
type 2 diabetes
high cholesterol levels
fats in blood

14. RISK FACTORS CT…
Conditions listed in previous slide can all lower urate filtration by
kidneys.
Gender and age
• Gout is about four times more common in men than women. It can
affect men of any age, but the risk is greater as one gets older
• Women rarely develop gout before menopause. This is because
the female hormone oestrogen increases how urate is filtered out
by the kidneys. But after menopause, oestrogen levels go down
and urate levels go up
Taking certain medications
• Some medications can reduce kidneys’ ability to get rid of
urate properly. These include diuretics and several medications for

15. RISK FACTORS CT…
Other conditions
• Several different conditions are linked with raised urate levels. This could be
because they affect the way the kidneys filter urate, or because they cause
more urate to be produced in the first place.
•For some conditions, the link with gout is less clear and may be due to many
different factors.
Common conditions associated with gout include:
 chronic kidney disease
 high cholesterol and fats in the blood
 high blood pressure
 type 2 diabetes
 osteoarthritis

16. TYPES OF FOOD WHICH CAN PREDISPOSE TO GOUT
Eating or drinking foods high in purines are more likely to lead to high uric
acid levels in the body and this can predispose an individual to gout. These
foods include:
 Sugary drinks and sweets: Any food or drink with high sugar content can
trigger gout
 High fructose corn syrup: This is a concentrated form of fructose.
Packaged food products and processed snacks can contain lots of high
fructose corn syrup
 Alcohol: Even though not all alcoholic drinks are high in purines, alcohol
prevents kidneys from eliminating uric acid, retained it in the body, where
it continues to accumulate
 Organ meats: These include liver, tripe, sweetbreads, brains and kidneys

17. TYPES OF FOOD WHICH CAN PREDISPOSE TO GOUT CT…
Game meats: Specialties such as goose, veal and venison all
contain high levels of purines
Certain seafood: Herring, scallops, mussels, codfish, tuna, trout
and haddock
Red meat: Beef, lamb, pork and bacon
Turkey: Especially processed deli turkey
Gravy and meat sauces

18. TRIGGERS OF GOUT ATTACK
A knock or injury to the joint
An illness that manifests with fever
Having an operation
Having an unusually large meal, especially a fatty meal
Drinking too much alcohol
Dehydration
Starting urate lowering therapy (ULT), especially at a high dose, or
not taking urate lowering therapy regularly daily as prescribed

19. CLINICAL MANIFESTATIONS
• Joint pain
• Joint swelling
• Tenderness to touch
• Warmth
• Redness
• Ankle Pain,
• Bumps Beneath Skin
• Foot Pain

20. CLINICAL MANIFESTATIONS
• Joint Lumps
• Joint Redness
• Joint Stiffness
• Discoloration or redness of affected area
• Toe Pain
• Toe Swelling
• Knee Pain

21. DIAGNOSTIC PROCEDURES
X-rays
Ultrasound
Magnetic resonance imaging (MRI)
CT (computed tomography) scan — specifically a dual-energy CT
scan
•Other common tests to diagnose gout include:
Blood tests to measure uric acid in blood
Joint aspiration — using a needle to remove a sample of fluid from
inside a joint

22. DIAGNOSTIC PROCEDURES CT…
Synovial fluid test
•This is a good way to confirm the diagnosis and rule out
other causes. This examination isdone by taking a sample of
synovial fluid, sent to laboratory to examined under a
microscope presence of urate crystals

23. MANAGEMENT
•Management of gout is symptomatic and supportive
•NSAIDs: Over-the-counter (OTC) NSAIDs, like ibuprofen
and naproxen, can reduce pain and swelling during a gout
attack if not contraindicated as in people with peptic ulcers
Colchicine: Colchicine is a prescription medication that can
reduce inflammation and pain if taken within 24 hours of a
gout attack
Corticosteroids: They also reduce inflammation. Route is
either intramuscularly into the affected joint

24. MANAGEMENT
Common medications that lower uric acid
Allopurinol
Febuxostat
Pegloticase
Probenecid

25. Things to be done in gout attack
Avoiding alcohol and sweet drinks
Drinking plenty of water
Elevating affected joints above the level of the heart as
often as one can.
Icing your joints. Wrap an ice pack in a thin towel or put a
cold compress on the affected joint for 15-20 minutes at a
time a few times a day
Limiting stress on the affected joint by avoiding intense
exercise or physical activities

26. PREVENTION
• The best way to prevent gout is to limit consumption of high-purine foods and
drinks
• Drinking plenty of water helps kidneys to function better and avoid
dehydration
• Exercise regularly to reduce stress on joints and reduce risk for obesity
• Most people with gout eventually find a combination of treatments and
lifestyle changes helpful in managing gout symptoms and reduce frequent
gout attacks
• Maintenance of blood uric level lower than 6 mg/dL makes an individual less
likely to experience gout attacks
• Fish, poultry, and other meat should be eaten in moderation to avoid gout
attacks. Some nutritionists recommend 0.113kg to 0.17kg a day of these foods

27. PREVENTION CT…
• Choosing a diet one can live with
• Drinking plenty of water may help flush out uric acid. Some nutritionists
recommend eight cups a day of liquids, at least half of them being water

28. DRINK MORE WATER

30. PREVENTIVE MEASURES CT…
•If you are overweight, losing weight can protect an
individual from gout hence flare-ups (loose weight)
However, losing weight fast can do more harm than good
for gout, as rapid weight loss can raise uric acid levels in
the bloodstream
EAT PLENTY OF FRUITS

31. PREVENTIVE MEASURES CT…
• Plant-based foods, fruits are healthy for the body. Eat plenty
fruits and vegetables daily
AVOID SWEETS AND SODAS

32. PREVENTIVE MEASURES CT…
•Unlike fruit with its natural sugar, artificial sugars are
widely recognized as gout flare dangers. Consuming too
many sugary sodas has been found to provoke attacks
EAT LESS MEAT

33. COMPLICATION
 Hypertension (high blood pressure).
 Chronic kidney disease.
 Obesity
 Diabetes
 Nephrolithiasis (kidney stones)
 Myocardial Infarction (heart attack)
 Congestive heart failure
 Severe arthritis and joint deformity
 Tophi (the plural form of tophus — a buildup of uric acid in the joints and soft
tissue)
 Permanent joint damage

34. Individual assignment
Read and make notes on the following:
1. Degenerative bone disease
2. HIV-related musculoskeletal diseases
3. TB of the bone

35. REFERENCE
• Bruna textbook of Medical-Surgical Nursing (electronic book)
• Barry A, Goldsworthy S & Gooridge D. (2014). Medical Surgical
Nursing in Canada; Assessment and Management of Clinical
Problems. Canada. 3rd Edition