Basic of Gout and Hyperuricemia

1. Gout &
Hyperuricemia
Presented By- Sanjoy Kumer Paul
ID: 2020-3-79-010
Submitted to- Dr. Farhana Rizwan
Associate Professor
Department of Pharmacy
East West University

2. ● Hyperucricemia.
● Etiology of Hyperuricemia.
● Epidemiology of Hyperuricemia.
● Differential Diagnosis of Hyperuricemia.
● Result of Hyperuricemia.
● Case Report.
● Gout.
● Symptoms of Gout.
● How Gout Occurs.
● Diagnosis of Gout.
● Risk Factors of Gout.
● Complication of Gout.
● Prevention of Gout.
● Treatment of Gout.
Contents

3. Hyperuricemia
 An elevated uric acid level in the blood.
 The normal upper limit is 6.8mg/dL, and anything over 7 mg/dL is considered saturated and
symptoms can occur.
 The elevated level is the result of increased production, decreased excretion of uric acid, or a
combination of both processes.
 Elevated uric acid can also be seen in accelerated purine degradation and decreased excretion.

4. Etiology of Hyperuricemia
Urate Overproduction
• Purine rich diet.
• Error of purine metabolism: Hypoxanthine phosphoribosyltransferase (HPRT) deficiency.
• Cell breakdown or turnover: Paget disease, psoriasis, tumor lysis, hemolysis, rhabdomyolysis, exercise.
Decreased Uric acid Excretion
• Acute or chronic kidney disease, acidosis (lactic acidosis, ketoacidosis), medication/toxin (diuretic, niacin,
ethambutol, cyclosporin, beryllium, salicylates, lead, alcohol), hyperparathyroidism, hypothyroidism, Bartter syndrome,
Down syndrome.

5. Epidemiology of Hyperuricemia
• As much as 21% of the general population.
• 25% of hospitalized patients have asymptomatic hyperuricemia.
• The most common complication of hyperuricemia is gout which is seen in 3.9% of the U.S. population.
• Hyperuricemia does not in itself indicate a pathological state because it is very prevalent in the general population.

6. Differential Diagnosis of Hyperuricemia
• Alcoholic ketoacidosis.
• Diabetic ketoacidosis.
• Gout and pseudogout.
• Hemolytic anaemia.
• Hodgkin lymphoma.
• Hyperparathyroidism.
• Hypothyroidism.
• Preeclampsia.
• Type 1a glycogen storage disease.

7. Result of Hyperuricemia
• Gout- An increased uric acid level in blood.
• Tophaceous gout- If anyone has hyperuricemia for several years, uric acid crystals can form clumps called tophi
that are found under skin, around joints, and in the curve at the top of ear.
• Kidney stones- Uric acid crystals can cause a buildup of stones in kidneys. Often, the stones are small and are
passed in urine. Sometimes, they can become too large to pass and block parts of urinary tract.

8. Case Report
A 46-years old male presented with an attack of knee arthritis with redness, pain and swelling. It is interesting
that the patient was HLA B27 positive antigen found a couple of years ago, but on admission he had a normal
findings of uric acid in serum, while cytological examination of synovial fluid obtained from knee joint no urates
were found. Therefore, diagnostically besides knee arthritis a reactive arthritis as well as other connective tissue
diseases were considered. In further diagnostic procedure Synovial Fluid Examination was performed and in
biopsy specimen from the cyst of lateral condyle higher level of urates were found. After the diagnosis was made
the treatment of gout with Indomethacin began, and with improvement of inflammation, surgery was performed--
cyst excochelation of lateral condyle of right femur with filling of the defect with an autologous graft from iliac
crest.

9. Gout
• Among the Asian Population the Chinese and Malaysian
have higher Uric Acid Level.
• 90% of gout attacks start in a single joint.
• Among people who have gout attacks, 90% have kidneys
that don’t remove enough uric acid from their urine while
10% make too much uric acid in their system.

10. What Is Gout?
 A form of inflammatory arthritis that results from an excess of uric acid in the blood.
 Characterized by sudden, severe attacks of pain, swelling, redness and tenderness in the joints.
 An attack of gout can occur suddenly. For example; often waking you up in the middle of the
night with the sensation that your big toe is on fire.
 Gout is genetically inherited and affects men more than women by a ratio of about 3 to 1.

11. • Intense joint pain.
• Lingering discomfort.
• Inflammation and redness.
• Limited range of motion.
 During an attack of gout the affected
joint becomes:
• Very painful.
• Tender.
• Red.
• Hot.
• Swollen.
Symptoms
of Gout

12. How Gout Occurs
Body produces uric acid when it breaks down purine that promote higher levels of
uric acid.
Urate crystals accumulate in the joint which cause the inflammation and intense
pain.
Sometimes either the body produces too much uric acid or the kidneys excrete too
little uric acid.
When this happens, uric acid can build up, forming sharp, needlelike urate crystals.

13. Diagnosis of Gout
Diagnosing gout is usually straightforward, especially if you have typical symptoms of the condition - for
example, if you have an attack in your big toe.
 Blood tests: Blood tests are done to measure urate levels that can be helpful to support a diagnosis of gout.
High urate levels in blood tests can suggest that you have gout, but this will need to be considered alongside
symptoms. It’s possible to have high levels of urate, but not have any other symptoms of the condition.
 Imaging tests: Ultrasound and CT scans can be good at spotting joint damage, crystals in the joints and
early signs of gout. X-rays are generally used to pick up the bone and joint damage caused by having gout for
a long time.
 Synovial fluid examinations: These are a good way to rule out other crystal conditions and make a
diagnosis. They’re done by taking a sample of your synovial fluid through a needle inserted into one of joints.
The fluid is then examined under a microscope for urate crystals. If anyone has tophi, doctors can take a
sample from one of those instead.

14. Risk Factors of Gout
 Diet: Rich in meat, seafood, drinking beverages sweetened with fruit sugar (fructose), alcohol consumption etc.
 Obesity: In case of overweight, body produces more uric acid and your kidneys have a more difficult time
eliminating uric acid.
 Medical conditions: Certain diseases and conditions increase risk of gout. Like, untreated high blood pressure and
chronic conditions such as diabetes, metabolic syndrome, and heart and kidney diseases.
 Certain medications: The use of thiazide diuretics — commonly used to treat hypertension — and low-dose
aspirin also can increase uric acid levels.
 Family history of gout: If any member of a family has gout, others are more likely to develop the disease.
 Recent surgery or trauma: Experiencing recent surgery or trauma has been associated with an increased risk of
developing a gout attack.
 Age and sex: Gout occurs more often in men, primarily because women tend to have lower uric acid levels. After
menopause, however, women's uric acid levels approach those of men.

15. Complication of Gout
People with gout can develop more-severe conditions, such as:
• Recurrent gout: Some people may never experience gout signs and symptoms again. Others may experience
gout several times each year. Medications may help prevent gout attacks in people with recurrent gout. If left
untreated, gout can cause erosion and destruction of a joint.
• Advanced gout: Untreated gout may cause deposits of urate crystals to form under the skin in nodules called
tophi (TOE-fie). Tophi can develop in several areas such as your fingers, hands, feet, elbows or Achilles tendons
along the backs of your ankles. Tophi usually aren't painful, but they can become swollen and tender during gout
attacks.
• Kidney stones: Urate crystals may collect in the urinary tract of people with gout, causing kidney stones.
Medications can help reduce the risk of kidney stones.

16. Prevention of Gout
● Drink plenty of fluids: Stay well-hydrated, including plenty of water. Limit to drink sweetened beverages,
especially those sweetened with high-fructose corn syrup.
● Limit or avoid alcohol: Recent evidence suggests that beer may be particularly likely to increase the risk of gout
symptoms, especially in men.
● Get protein from low-fat dairy products: Low-fat dairy products may actually have a protective effect against
gout, so these are your best-bet protein sources.
● Limit intake of meat, fish and poultry: A small amount may be tolerable, but pay close attention to what types
— and how much — seem to cause problems for patients.
● Maintain a desirable body weight: Choose portions that allow you to maintain a healthy weight. Losing weight
may decrease uric acid levels in your body. But avoid fasting or rapid weight loss, since doing so may
temporarily raise uric acid levels.

18. Treatment of Gout
● Non-steroidal anti-inflammatory drugs (NSAIDs): It can help with pain and reduce some of
inflammation. Indomethacin, Ibuprofen, Naproxen and diclofenac are NSAIDs that could be given.
If anyone has been prescribed NSAIDs to treat an attack, should start taking them as soon as he/
shenotice signs of one coming on.
● Colchicine: It isn’t a painkiller, but can be very effective at reducing the inflammation caused by
urate crystals. As with NSAIDs, colchicine tablets should be taken as soon as you notice an attack
coming on, or it may not work as well.
● Steroids: If colchicine or NSAIDs do not work properly, or if you’re at risk of side effects from
these drugs, doctor may prescribe steroids. They are usually taken as a short course of tablets,
lasting a few days. However, these can also be taken as an injection into a muscle or joint affected
by gout. This can be particularly helpful if gout is affecting only one joint.

19. Treatment of Gout
● Allopurinol: It works by reducing the amount of urate that your body makes. You’ll start on a low dose of
allopurinol, which can be gradually increased until you are on the right dose.
● Febuxostat: is a newer drug that reduces the amount of urate made in the body in the same way that
allopurinol does but instead of being broken down by the kidneys, it’s broken down by your liver. It’s useful
if anyone has kidney problems and can’t take a high enough dose of allopurinol.
● Uricosuric drugs: which include sulfinpyrazone, and probenecid. These work by flushing out more urate
than normal through your kidneys.

20. CREDITS: This presentation template was
created by Slidesgo, including icons by
Flaticon, infographics & images by Freepik and
illustrations by Stories

21. CREDITS: This presentation template was
created by Slidesgo, including icons by
Flaticon, infographics & images by Freepik and
illustrations by Stories

22. ● https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897
● https://www.healthline.com/health/hyperuricemia#treatment
● https://www.healthline.com/health/hyperuricemia#symptoms
● http://chemocare.com/chemotherapy/side-effects/hyperuricemia-high-uric-acid.aspx
● https://www.hss.edu/condition-list_ gout.asp
● https://www.versusarthritis.org/about-arthritis/conditions/gout/
●https://www.ncbi.nlm.nih.gov/books/NBK459218/#:~:text=Hyperuricemia%20is%20an%20elevated
%20uric,a%20combination%20of%20both%20processes.
● https://www.versusarthritis.org/about-arthritis/conditions/gout/
References