The document discusses gout, a type of arthritis caused by uric acid crystals in the joints. It defines gout, lists its symptoms such as sudden severe pain in joints like the big toe, and describes its typical progression from asymptomatic to acute attacks to a chronic condition if left untreated. Risk factors include being male, obesity, diet high in purines, and certain medications. Diagnosis involves examining synovial fluid for uric acid crystals. Treatment focuses on relieving acute attacks, preventing future attacks by reducing uric acid levels in the blood long-term through medications and diet changes, and managing chronic complications through continued medical care.
3. Introduction
Gout comes from Latin gutta and old French
gote meaning "a drop."
Several hundred years ago gout was thought to
be caused by drops of viscous humors that
seeped from blood into the joints
Gouty arthritis in one or more joints (but less
than four)
May be precipitated by trauma, surgery, alcohol
ingestion, or infection
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4. Definition
It can be defined as the pathological reaction of
the joint or periarticular tissues to the presence
of monosodium urate monohydrate crystals
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5. Epidemiology
• About 10% of people with hyperuricemia
develop gout at some point in their lifetimes
• Depending on the degree of hyperuricemia
▫ When levels are between 415 and 530 μmol/l (7
and 8.9 mg/dl), the risk is 0.5% per year
▫ while in those with a level greater than 535 μmol/l
(9 mg/dL), the risk is 4.5% per year.
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6. The Four Stages of Gout
• Asymptomatic
• Acute
• Intercritical
• Chronic
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7. ASYMPTOMATIC
• A- meaning without indicates that there are
no symptoms associated
• Patient will be unaware of what is happening
• Gout can only be determined with the help of
a physician
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8. ACUTE
• Sever and sudden onset
• Involve one or a few joints
• Frequently starts
nocturnally
• Joint is warm, red, and
tender
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9. INTERCRITICAL
• More concentration
of uric acid crystals
• Typically no need for
drug intervention at
the time.
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10. CHRONIC
• Continuous or
persistent over a long
period of time
• Treatment required
• Not easily or quickly
resolved
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11. Clinical Manifestations
Onset usually nocturnal, with sudden swelling and
excruciating pain
Joint pain usually begins over 2–4 hours and
during the night
May have low grade fever
Usually subsides within 2-10 days
Joints are normal, with no symptoms between
attacks
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12. Other Symptoms
• the heels, knees, wrists, and fingers, may also be
affected
• The reason for onset at night is due to the lower
body temperature
• Other symptoms may rarely occur along with the
joint pain, including fatigue and a high fever
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13. Causes
• Diet
• Genetic predisposition (SLC2A9, SLC22A12, and ABCG2)
• Under excretion of urate (90%)
• The salts of uric acid
• Insulin resistance
• Regular aspirin and niacin use
THE MAIN CAUSE IS THE IMBALANCE BETWEEN THE
INTAKE AND EXCREATION.
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14. Risk factors
• Males after the age of 20
• Female after menopause
• High BMI
• Diet rich in seafood
• HTN
• Thiazide diuretics
• Excess alcohol use
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15. Pathophysiology
Uric acid is end product of purine metabolism
and is excreted by the kidneys
Hyperuricemia
Diet high in purines will not cause gout, but may
trigger an attack in a susceptible person
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17. Complications
Joint deformity
Osteoarthritis
Tophi may produce draining sinuses that may
become infected
Renal stones, pyelonephritis, obstructive renal
disease
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18. Tophi-(Solid urate deposits in tissues)
Gross appearance of tophi X-ray view of a tophi
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19. Diagnosis
History & physical examination
Clinical symptoms alone are sufficient to make
accurate DX in most cases
Family history of gout
Diagnostic studies
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20. Diagnostic Studies
Serum uric acid levels
420 μmol/l (7.0 mg/dl) in males and 360 μmol/l
(6.0 mg/dl) in females
WBC elevated during acute attack
ESR
24 hour urine uric acid levels
Synovial fluid aspiration contains uric acid crystals
Seldom necessary
X-rays appear normal in early stages; tophi appear
as eroded areas of bone
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21. SYNOVIAL FLUID ANALYSIS
(Polarized Light Microscopy)
The Gold standard
Crystals intracellular during attacks
Needle & rod shapes
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22. Treatment protocol
Acute attack
Colchicines produces dramatic anti-inflammatory
effects with relief within 24-48 hours
NSAIDs for additional pain relief
Corticosteroids (intra-articular)
Adrenocorticotropic hormone (ACTH)
Joint aspiration to decompress
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23. Prevention of acute attacks
Colchicine combined with:
Allopurinol (zyloprim, alloprim) – blocks
production of uric acid
Probenecid (benemid), sulfinpyrazone (anturane) –
inhibit tubular reabsorption of uric acid
Febuxostat (uloric) – inhibits xanthine oxidase,
recently shown to reduce serum uric acid levels
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24. Dietary measures
Weight reduction
Avoidance of alcohol
more low-fat dairy products
Avoidance of foods high in purines
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High: mussels, liver, kidney, meat soups, sweetbreads, beer & wine
Moderate: Chicken, salmon, crab, mutton, pork, beef, ham
Vitamin C intake of 1,500 mg per day decreases the risk of gout
by 45%
Coffee, but not tea, consumption is associated with a lower risk
of gout
25. What we can eat without fear
Bread (white) and crackers
Butter or margarine (in moderation)
Cake and cookies
Carbonated beverages
Cereals
Cheese
Chocolate
Coffee
Cream (in moderation)
Custard
Eggs
Fats (in moderation)
Fruit
Gelatin desserts
Herbs
• Ice cream
• Milk
• Noodles
• Nuts
• Oil
• Olives
• Pickles
• Pasta
• Popcorn
• Puddings
• Relishes
• Rice
• Salt
• Sugar and sweets
• Tea
• Vegetables (except those mentioned
in the first group)
• Vinegar
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26. Home remedy
Raise and rest your limb
Use a splint to immobilize the joint
Do not do vigorous exercise
apply an ice pack or bag of frozen vegetables wrapped in a towel
Do not cover the joint.
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27. Acupuncture
• Sedative points- gv-20,
• Homeostasis point-Li-11
• Analgesic point- st-44
• Immune mechanism- Du-14, Sp-6, St-36
• Influential point-UB-17, UB-11
• Point for Pruritis-Sp-10,UB-16
• Some local points
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