A 30 yrs old female age of 45 years was admittedSudden and severe pain in a joint ,usually in the middle of the night or early morning since 3 mths was diagnosed as Gout

1. CASE PRESENTATION ON
GOUT
P.Asma Afreen
15EA1T0018
Pharm.D V Yr

2. PATIENT DETAILS
Name :- Sravani
Age :- 45 years
Gender :- Female
Ward :- Female medical ward

3. CHIEF COMPLAINTS
Sudden and severe pain in a joint ,usually in the
middle of the night or early morning since 3
months.
Tenderness in the joint.
Stiffness in the joint

4. ON EXAMINATION
GC :- Fair
BP :- 120/80mmHg
RS :- NVBS
PR :- 80 Bpm
CVS :- S1 S2 Present
P/A :- Soft

5. LAB INVESTIGATIONS
CBP RESULT NORMAL VALUES
HB 12 gm/dl 13.0-18.0gm/dl
TC(WBC) 6000 cells/cumm 4000-11000cells/cumm
Neutrophiles 57 % 40-70%
Eosinophiles 04 % 0-6%
Lymphocytes 30 % 20-45%
Monocytes 03 % 02-10%
Platelets 2.0 lakhs /cumm 1.5-4.0lakhs/cumm
S. Creatinine 3 mg/dl 0.6-1.2mgdl
Uric acid 8.0 mg/dl 2.5 – 7.5 mg/dl

6. DIAGNOSIS
GOUT

7. SOAP NOTES
SUBJECTIVE
A 30 yrs old female age of 45 years was admitted in
female surgical ward of vishwa bharathi hospital with
the chief complaints of following:
Sudden and severe pain in a joint ,usually in the middle
of the night or early morning since 3 mths.
Tenderness in the joint.
Stiffness in the joint

8. OBJECTIVE
S.NO TEST RESULT NORMAL VALUES
1 HB 12 gm/dl 13.0-18.0gm/dl
2 S. Creatinine 3 mg/dl 0.6-1.2mg/dl
3 Uric acid 8.0 mg/dl 2.5 – 7.5 mg/dl
Joint fluid analysis( aspiration ):
Urate crystals was observed

9. ASSESSMENT
Based on the subjective and objective finding the
physician diagnosed that the patient was suffering
from
Gout

10. DEFINITION
Gout is a form of inflammatory arthritis that develops in
some people who have high levels of uric acid in the
blood. The acid can form needle-like crystals in a joint
and cause sudden, severe episodes of pain, tenderness,
redness, warmth and swelling.

11. ETIOLOGY
• Mechanism to excrete the uric acid is defective.
• Over production of uric acid
• Medications
• Purine rich foods
• Hyperuricaemia may also be caused by blood conditions
such as lymphoma, leukaemia and haemolytic anaemia
(where blood cells are destroyed), and by other cancers
or psoriasis
• Some foods may contribute to high blood levels of urate

12. PATHOPHYSIOLOGY

13. CLINICAL MANIFESTATIONS
• Intense joint pain.
• Lingering discomfort: After the most severe pain
subsides, some joint discomfort may last from a few
days to a few weeks.
• Inflammation and redness: The affected joint or joints
become swollen, tender, warm and red.
• Limited range of motion

14. DIAGNOSIS
• Joint fluid test. Doctor may use a needle to draw fluid from your
affected joint. Urate crystals may be visible when the fluid is
examined under a microscope.
• Blood test. Doctor may recommend a blood test to measure the
levels of uric acid and creatinine in your blood.
• X-ray imaging. Joint x-rays can be helpful to rule out other causes
of joint inflammation.
• Ultrasound. Musculoskeletal ultrasound can detect urate crystals
in a joint or in a tophus..
• Dual energy ct scan. This type of imaging can detect the presence
of urate crystals in a joint, even when it is not acutely inflamed..

15. STANDARD THERAPY
• Nonsteroidal anti-inflammatory drugs (NSAIDS). Nsaids include over-the-
counter options such as ibuprofen (advil, motrin IB, others) and naproxen
sodium (aleve), as well as more-powerful prescription nsaids such as
indomethacin (indocin) or celecoxib (celebrex).
• Colchicine. Doctor may recommend colchicine (colcrys, mitigare), a type of
pain reliever that effectively reduces gout pain.
• Corticosteroids. Corticosteroid medications, such as the drug prednisone, may
control gout inflammation and pain.
• Corticosteroids are generally used only in people with gout who can't take
either nsaids or colchicine..

16. Medications to prevent gout complications:
• Medications that block uric acid production. Drugs called xanthine
oxidase inhibitors (xois), including allopurinol (aloprim, lopurin, zyloprim)
and febuxostat (uloric), limit the amount of uric acid your body makes.
This may lower your blood's uric acid level and reduce your risk of gout.
• Medication that improves uric acid removal. These drugs, called
uricosurics, include probenecid (probalan) and lesinurad (zurampic).
Uricosuric drugs improve your kidneys' ability to remove uric acid from
your body. This may lower your uric acid levels and reduce your risk of
gout, but the level of uric acid in your urine is increased.

17. S.no Brand name Generic
name
Dose ROA Freque
ncy
1 2 3 4 5
1. Colcrys Colchicine 1.2 g oral BD     
2 Orudis Ketoprofen 100mg oral BD     
3. Aleve Naproxen 200mg Oral BD     
4. Ij. Rantac Ranitidine 150 mg IV BD     
PLAN

18. PHARMACIST INTERVENTIONS
DRUG – DRUG INTERACTIONS
• Ketoprofen  naproxen
Effect: Both increase anticoagulation & serum
potassium.
Management: By changing frequency or using
alternative drug

19. PATIENT COUNSELLING
• Limiting alcoholic beverages and drinks sweetened with fruit sugar (fructose).
Instead, drink plenty of nonalcoholic beverages, especially water.
• Limiting intake of foods high in purines, such as red meat, organ meats and
seafood.
• Exercising regularly and losing weight. Keeping your body at a healthy weight
reduces risk of gout.
Certain foods have been studied for their potential to lower uric acid levels,
including:
• Coffee
• Vitamin C. Supplements containing vitamin C may reduce the levels of uric
acid in blood.
• Cherries. Cherries have been reported to lower levels of uric acid, as well as
reduce the number of gout attacks. Eating more cherries and drinking cherry
extract may be a safe way to supplement your gout treatment.
• Drink plenty of fluids. .
• Limit your intake of meat, fish and poultry.
• Check uric acid levels twice a year