Gout is a type of crystal arthritis characterized by high uric acid levels in the blood and painful attacks of acute arthritis, typically in the big toe joint. It is more common in males than females and can be caused by increased uric acid production or decreased excretion. Acute gout causes sudden, severe pain and swelling in joints like the toe and chronic gout leads to tophi deposits under the skin and possible joint damage over time if untreated. Diagnosis involves examining joint fluid for urate crystals under polarized light and treating acute attacks involves NSAIDs, colchicine, or steroids while long term treatment focuses on uric acid lowering drugs like allopurinol.

1. Introduction
 Gout is one of the crystal arthritis : gout, pseudogout
and hydroxyapatite arthopathy.
 Gout is characterised by:
 A rise in the serum level of uric acid.
 Attacks of acute arthritis , tenosynovitis or bursitis
related to the deposition of urate crystals.
 Presence of tophi- vicinity of peripheral joints and ear
pinna
 Renal disease
 Renal calculi

2. Ruchika gupta

3. Prevalance
 Male: female:: 1 :6
 Uric acid levels vary and normal values does not
exclude the disease.
 Either increased production or decrease excretion.

4.  Painful acute condition ,acute condition.
 In over 70% metatarso phalangeal joint of big toe ,which
becomes red ,hot, swollen and equisitely tender such that even
bed clothes resting on it result in agony.
 May be spontaneous or may be precipitated by some factors
(trauma,surgery,starvation diets,etc),.diuretics
(irony:allopurinol,uricosuric)
 Acute attack include the ankle ,knee, hands and wrists (
presentation may resemble septic arthritis).
 Rare before puberty in males and before menopause in female.
 symptoms and sign settle with desquamentation of skin
overlying the joint but can recur.
Acute gout

5. Chronic gout
 Sequela of acute gout attacks.
 Radiological studies may maquerade osteoarthritis
especially in elderly women in small joints.
 Tophi has to be differentiated by xanthomata .
 Chronic tophi may resemble nodular RA.
 Sometimes tophi stimulate infection and present as a
discharging lesion .
 Renal calculi in approx 10 % patient.

7. Diagnosis
 X Ray
 Joint fluid examination: monosodium urate crystal in
polarising light microscopy (acute), urate( chronic)
 Biopsy : tophus : urate
 Serum: uric acid level raised
 RA factor : negitive

9. Treatment
 Acute: NSAIDS, indomethacin,diclofenac injection or
oral, azapropanol,colchicine, corticosteroids,rest.
 Long term management: recuurent(>2yr),chronic
gout,renal disease,persistently high uric acid +HT.
allopurinol (after acute attack is subsided, cont.renal
and hepatic disease, continued for long) +NSAID
Uricosuric drugs (probenecid,sulphinpyrazone)

11. Physiotherapy in gout
 Acute: icing , compression, elevation, positioning ,
, prevention of involvement of other joints by aerobic
exercises, walking , running, general ROM exercises
and free exercises, improvement in diet.
 Chronic : functional independence , QOL
improvement,compensatory devices like prosthesis or
orthosis, ETC