Gout is a type of inflammatory arthritis caused by high levels of uric acid in the blood (hyperuricaemia). It is more common in developed countries and affects males much more frequently than females. Gout is caused by either increased production or decreased excretion of uric acid. It presents as acute attacks of painful, red, swollen joints or as chronic arthritis. Diagnosis involves examining joint fluid or testing blood uric acid levels. Treatment focuses on reducing inflammation during attacks and lowering uric acid levels long-term using medications like allopurinol, probenecid, corticosteroids, or lifestyle changes.

1. GOUT

2.  Condition of inflammatory arthritis associated w/
hyperuricaemia.
 Epidemiology:
• More prevalent in developed countries.
• Males : Females (10:1)
 Etiology: 2 causes
• Increased uric acid synthesis
• Decreased uric acid excretion
[Hyperuricaemia:
• Increased concentration of urea and uric acid in the blood
• > 420 µmol / L (males)
• > 360 µmol / L (females)]

3. Etiology (contd’.)
 Increased uric acid synthesis (10% cases)
• Uric acid is formed in the purine pathway.
• Increased uric acid synthesis is observed in…
▪ Increased purine synthesis
▪ Action of phosphoribosyl pyrophosphatase enzyme
▪ G6PD deficiency (in Type-II DM)
▪ Carcinoma, Leukaemia, Polycythemia vera
 Decreased uric acid excretion (90% cases)
• Seen in HTN; 1° hyperparathyroidism; hypothyroidism;
• Drugs (thiazide diuretics, low dose aspirin)
• Decreased concentration of G6PD
• Increased concentration of lactic acid (alcohol, starvation,
exercise)

4. Dx:
 Joint fluid microscopy (specific test but, risky and difficult)
 Blood tests (increased urate levels; > 600 µmol / L)
CLINICAL FEATURES : 4 Types
1] Acute Gout:
• In middle-aged persons;
• Sudden onset; swelling, redness, severe pain; occurs any time;
• w/ out Tx, lasts for a week, then gradually person ‘recovers’
2] Chronic polyarticular gout:
• Affects old people; mainly RF patients; those on diuretic Tx

5. 3] Chronic Tophaceous Gout :
• Tophi in skin, joints, ear lobes etc….
• Results in ulceration
• X-ray reveals bony cysts
4] Urate Renal stone formation

8. Tx :
1] Anti-inflammatory agents
(a) NSAIDs
• Naproxen (500 mg Q8H or Q12H; upto 750 mg)
• Diclofenac (50 mg Q6H or Q8H; upto 75 – 100 mg)
• Indomethacin (50 mg Q6H or Q8H; upto 75 – 100 mg)
• Colchicine (500 mg Q6H or Q12H; upto 1gm)
(b) Corticosteroids (Methyl prednisolone via IM or IA)
2] Serum urate reducers
• Allopurinol (50 – 100 mg; upto 300 – 600 mg; can
cause skin rash)
• Uricosuric agent (Probenecid 0.5 - 1 gm Q12H)
• Allopurinol + Probenecid combination is preferred for
chronic tophaceous gout.
3] Diet
• Avoid alcohol, beer, shellfish and spinach (high purine
content).

9. THE END

10. THE END