Gout is a type of arthritis caused by high levels of uric acid in the blood. It most commonly affects the big toe joint, causing sudden and severe pain. There are different types of gout including acute gout, chronic gout, and pseudogout. Risk factors include being overweight, drinking alcohol, eating red meat, and using diuretics. Treatment involves medications to reduce uric acid levels and prevent attacks, as well as lifestyle changes like losing weight, staying hydrated, and following a diet low in purines and high in fruits and vegetables.

1. GOUT
Presented to: Miss Makkia
"Disease Prevention through Nutrition"
Doctor of Diet & Nutritional Sciences
Section: "B"
Semester: Third (3rd)

2. DEFINITION:
"A metabolic disease characterized by recurrent attack of acute inflammatory arthritis caused by elevated levels of
uric acid in the blood (Hyperuricemia)"
• Nicknamed the "Disease of Kings"because it is caused by rich foods, alcohol and royalty often had it.
• Most common rheumatic disease of adulthood.
• The uric acid crystallizes & deposits in joints,tendons and sorrounding tissues.
• Hyperuricemia :
Over production/Under excretion/Both
Hyperuricemia Gout
Hyperuricemia: Serum uric acid>7mg%(male) & >6mg%(female)

3. Types of Gout:
• Gouty Arthritis
I. Acute gout
II. Inter critical gout
III.Chronic gout
• Psueodogout
• Podagra

4. a. 1st metatarsophalangeal joint (podagra)
b. Forefoot/ instep
c. Ankle joint
d. Knee joint
e. Wrist joint
f. Elbow joint
g. Finger joint
• O/E: erythematous, warm, swelling over involved joint with extreme tenderness +/- fever( skin
desquamation)
• Duration: 2-3 weeks, gradual complete resolution of inflammatory signs.

5. GOUTY ARTHRITIS:
a. Acute Gout:
 Acute, Self limiting, monoarticular
 Painful, red hot, swollen
 Usually resolves within 2 weeks if untreated
 May occur even if serum urate is normal
 LL>UL
 Commenly affected joints

6. PODAGRA:
• This is a common form of gout and the one that we hear of most often.
• Urate crystals gather in the joint of the big toe, and this is actually one of the first signs that one has gout.
• Most middle-aged patients who develop gout have podagra.
• You will know if you have this type of gout because your big toe will be swollen, sore, and red.
• This type of gout can be so painful that some sufferers can’t even wear socks or let
the bed sheets lay on top of their feet.

7.  Inter critical Gout:
Asymptomatic periods between attack
 Chronic Gout:
• If you have this type of gout, you will experience chronic, recurrent attacks.
• Urate crystals may appear in your ear, over the tip of your elbow, and in the joints of your fingers.
• If left untreated, the affected joint could end up being destroyed over time as it will begin to erode.
• The affected joints could end up looking like rheumatoid arthritis. But, you can distinguish between the two
because there are no urate crystals deposited in the joints when you have rheumatoid arthritis.
• This type of gout develops about 10 years following the first acute gout attack, particularly if treatment is not
sought

8. What Causes Gout?
• The body doesn't process uric acid properly
• Blood has high level of uric acid (hyperuricemia)
• Uric Acid precipitates out in the joints, cause swelling
• Certain foods are high in purines, which increase uric acid production
• Causes of an elevated blood uric acid level (hyperuricemia) include genetics, obesity, certain medications
such as diuretics (water pills), and chronic decreased kidney function.

9. RISK FACTORS:
There are many risk factors for gout,
• After surgery
• Trauma
• Dehydration
• Certain medication such as Diuretics
• Low dose of Aspirin
• Cancer
• Degenerative Arthritis

10. Signs & Symptoms:
The characteristic symptoms and signs of gout are:
• Sudden onset of joint pain,
• Joint swelling
• Joint redness
• Heat in the affected area
• Reddish & Itching skin around the affected joint
• Limiting movement
• Usually acute pain at night pain

11. INVESTIGATION:
Specific investigations for confirmation
• Serum Uric acid
• Joint aspiration & Crystal identification (Not widely available)
• plain radiographs (may be normal)
• Synovial biopsy
• serum cretinine/urea
• serum blood glucose
• Fasting lipid profile
• 24hr urinary urate excretion:

12. Treatment:
ACUTE TREATMENT: PREVENTION OF RECURRENCE :
• NSAID's Modify Risk factors
caution in renal Obesity,Alcohol,Red meat,Thiazides
insufficiency & peptic ulcer
• Colchicine Uricosuric Agents
Diarrahea,Bone marrow, probenicid,Sulfinpyrazone
Suppression Contribute to kidney stones
• Steroids Xanthine oxidase Inhibitors
Oral,IV or intra Articular Allopurinol, febuxostat
injection Can precipitate accute attack

14. PREVALENCE OF GOUT IN PAKISTAN & INTERNATIONAL:
• Exact prevalence of gout in Pakistan is not known
• In USA and Europe, it is about 0.3% while in Newzealand, it is 10.3% in men and 4.3% in women.
• Over 90% of patients with primary gout are men. The peak age in men is earlier than women, who rarely
develop the disease before menopause

15. DIET TO TREAT & PREVENT GOUT:
The general principles of a gout diet are essentially the same as recommendations
for a balanced, healthy diet:
1. Weight Loss:
Being overweight increases the risk of developing gout, and losing weight
lowers the risk of gout.
2. Complex Carbs:
Eat more fruits, vegetables and whole grains, which provide complex carbohydrates. Avoid foods such as
white bread, cakes, candy, sugar-sweetened beverages and products with high-fructose corn syrup.
3. Water:
Keep yourself hydrated by drinking water. An increase in water consumption has been linked to fewer gout
attacks. Aim for eight to 16 glasses of fluids a day

16. 4. Fats:
Cut back on saturated fats from red meats, fatty poultry and high-fat dairy products
5. Proteins:
Limit daily proteins from lean meat, fish and poultry to 4 to 6 ounces (113 to 170 grams). Add protein to your
diet with low-fat or fat-free dairy products
6. High purines vegetables:
A healthy diet based on lots of fruits and vegetables can include high-purine vegetables, such as asparagus,
spinach, peas, cauliflower or mushrooms. You can also eat beans or lentils, which are moderately high in
purines but are also a good source of protein.
7. Organ and glandular meat:
Avoid meats such as liver, kidney and sweetbreads, which have high purine levels and contribute to high
blood levels of uric acid

17. 8.Selected Sea foods:
Avoid the following types of seafood, which are higher in purines than others: anchovies, herring, sardines,
mussels, scallops, trout, haddock, mackerel and tuna.
9.Vitamin C:
Vitamin C may help lower uric acid levels. Talk to your doctor about whether a 500-milligram vitamin C
supplement fits into your diet and medication plan.
10.Coffee:
Some research suggests that moderate coffee consumption may be associated with a reduced risk of gout,
particularly with regular caffeinated coffee.
11.Cherries:
There is some evidence that eating cherries is associated with a reduced risk of gout attacks.

18. Breakfast:
• Whole-grain, unsweetened cereal with skim or low-fat milk
• 1 cup fresh strawberries
• Coffee
• Water
Lunch:
• Roasted chicken breast slices (2 ounces) on a whole-grain
roll with mustard
• Mixed green salad with balsamic vinegar and olive oil
dressing
• Skim or low-fat milk

19. • Water
Afternoon snack:
• 1 cup fresh cherries
• Water
Dinner:
• Roasted salmon (3-4 ounces)
• Roasted or steamed green beans
• 1/2 cup whole-grain pasta with olive oil and lemon pepper
• Water
• Low-fat yogurt
• 1 cup fresh melon
• Caffeine-free beverage, such as herbal tea

20. • CONCLUSION:
• Gout is under-treated
• The majority of patients will respond to inexpensive drugs
• Optimal treatment will lead to long term benefits to health community & individual patients both in term
of improved health & reduction in utilization of sources