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Gout
Crystal deposition diseases like gout result from the deposition of crystals like urate in joints and surrounding tissues. Gout is caused by elevated uric acid levels resulting from purine metabolism abnormalities. It usually affects middle-aged males and post-menopausal females, causing sudden, severe joint pain and inflammation. Diagnosis is confirmed by identifying urate crystals in joint fluid. Treatment involves lifestyle changes, medications like allopurinol and NSAIDs to prevent attacks and reduce uric acid levels.
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Gout
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- 2. Crystal deposition disease Groupof conditions : presence of crystals in & around joints, bursae & tendons • Gout • CPPD (calcium pyrophosphate dihydrate) • Hydroxyapatite
- 3. GOUT Consequences : crystaldeposition • Remains inert and asymptomatic • Induces acute inflammatory reaction • Slow destruction of the affected tissue
- 4. Gout • Disorder ofpurine metabolism • Common in males m:f = 20:1 • In females after menopause • Hyperurecemia – Monosodium urate monohydrate crystals • Recurrent acute synovitis Two types: • Primary 95%: Inherited disorder • Over production / under excretion of uric acid • Secondary 5% : Acquired condition • Over production • Myeloproliferative disorders • Under excretion • Renal failure
- 5. Two types: • Primary95%: Inherited disorder • Over production / under excretion of uric acid • Secondary 5% : Acquired condition Over production Under Excretion (renal Failure) • Myeloproliferative disorders
- 6. Gout Pathology : • Allpatients with a high serum uric acid do not develop gout • Crystals are deposited in minute clumps : remain inert for years • Local trauma ? disperses crystals into joint : acute inflammatory reaction
- 7. Pathology .. Gout… •Each crystal : phagocytosed or float free in the joint • Over years, urate deposits build up in joints , periarticular tissue,tendon and bursa :destroy articular cartilage and periarticular bone
- 8. Pathology : Common sitesof deposition : • MTPJ of great toe • Achillis tendon • Olecrenon bursa • Pinna of the ears • Tophi : < 1cm to several cms : may ulcerate through the skin Gout
- 9. Gout Clinical features : •Men > 30 yrs of age • Women after menopause • Obese, hypertensive, alcohol friendly • Patients on diuretics : (increases tubular re-absorption of uric acid) • Family history : positive
- 10. Gout Acute gout : •Sudden severe joint pain, ? precipitated by • Minor trauma • Surgery • More in the night • Lasts for 1-2 wks and completely resolves • Minor illness • Unaccustomed exercise • Alcohol
- 12. Gout Clinical features: AcuteGout • Common sites are affected • Joint hot and tender : d/d : septic arthritis • Hyperurecemia not diagnostic • Diagnosis confirmed by synovial fluid analysis for negatively bifringent urate crystals
- 13. Gout Chronic gout Recurrent attacks •increased joint stiffness & deformity • Tophi appear over the common sites • Large tophi may ulcerate the skin • Chalky material discharged • Renal calculi, renal parenchymal disease
- 14. Gout Radiology : Acute gout: Only soft tissue swelling Chronic gout • Tophi appear as punched out lesions (cysts) in the para- articular bone ends • Secondary osteoarthrosis • Infected bursitis
- 15. Gout Differential Diagnosis: • Infection •Cellulitis • Septic arthritis • Infected bursitis Reiter’s disease • History more protracted • Response to Nsaids less
- 16. Gout Differential Diagnosis : Pseudogout •Affects larger joints • More common in women • Pyrophosphate dihydrite crystalsdeposition Rheumatoid arthritis • Polyarticular gout : affecting fingers • Elbow tophi : mistaken for subcutaneous nodule – Biopsy establishes diagnosis
- 17. Gout Treatment Acute stage • Restto the joint • Nsaids • Aspiration Interval therapy • Loose weight • Reduce alcohol • Eliminate diuretics • Urocosuric drugs – allopurinol Interval therapy indicated : • Acute attacks occur at frequent intervals • Presence of tophi • When renal function is affected • Colchicine less effective • Intra-articular hydrocortisone
- 19. Gout Interval therapy • Looseweight • Reduce alcohol • Eliminate diuretics • Urocosuric drugs – allopurinol Interval therapy indicated : • Acute attacks occur at frequent intervals • Presence of tophi • When renal function is affected
- 20. Gout Interval therapy: • Urocosuricdrugs : if renal function is normal • Allopurinol : xanthine oxidase inhibitor : preferred – These drugs are never started in acute stage – They should be always covered by NSAID’s / Colchicine as they will otherwise precipitate an attack of gout Chronic gout: • Allopurinol is the drug of choice • Ulcerating tophi may have to be evacuated