The document summarizes information about gouty arthritis, including its clinical presentation, stages, and dietary considerations. Gouty arthritis causes extremely painful episodes of monoarticular inflammation, usually in the big toe, ankle, or knee. It has an intermittent course and a tendency to abuse NSAIDs. Later stages involve multiple joints and deposits of uric acid crystals called tophi under the skin, which can damage joints. The document outlines the stages from asymptomatic hyperuricemia to acute attacks to chronic tophaceous gout. It also discusses associated risks like kidney stones, kidney disease, and joint damage if left untreated, in addition to psychological impacts of the pain. Dietary advice separates foods into low, moderate, and

1. GOUTY
ARTHRITIS

2. GENERALITIES
EXTREMELY PAINFUL EPISODES
OF ARTHRITIS
INTERMITTENT COURSE,
USUALLY MONOARTICULAR IN
VOLVING THE BIG TOE, ANKLE,
KNEE
MAY LATER BE OLIGO-
OR POLYARTICULAR
TENDENCY TO ABUSE NSAIDS
(AND STEROIDS)
MAY BE PRECIPITATED BY
STRESS E.G SURGERY, BLOOD
TRANSFUSION

3. Gouty Arthritis: Clinical
Presentation
• Precipitated by local
trauma unaccustomed exercise
& alcohol consumption
• Excruciating pain over
hours frequently nocturnal

4. Gouty Arthritis:
Clinical Presentation
• Swelling, redness & tenderness
• Monoarticular & lower
extremities
-May affect knees, wrist, elbow
& rarely SI & hips

5. Stages of Gouty
Arthritis

6. Asymptomatic Hyperuricemia
-Abnormal high serum urate level, without gouty arthritis or nephrolithiasis
Acquired Causes of Hyperuricemia:
• Increased Urate Production
Causes: Drugs (i.e ethanol, cytotoxic drugs), excess purine, alcohol, fructose consumption,
hematologic problem (i.e Myeloproliferative and lymphoproliferative disorders , polycythemia),
obesity, psoriasis, hypertriglyceridemia
• Decreased Renal Excretion of Urate
Causes: Drugs (i.e Ethanol, cyclosporine (Sandimmune), thiazides, furosemide (Lasix) and other
loop diuretics, ethambutol (Myambutol), pyrazinamide, aspirin (low-dose), levodopa
(Larodopa), nicotinic acid (Nicolar)), hypertension, polycystic kidney disease, chronic renal
failure, dehydration, lactic acidosis, ketosis, hypothyroidism, hyperparathyroidism, obesity,
sarcoidosis, toxemia of pregnancy

7. Acute Gouty Arthritis
Characterized by the sudden
onset of pain, erythema, limited
range of motion and swelling of
the involved joint

8. Intercritical Gout
Asymptomatic phase or intervals between attacks
of gouty arthritis. A patient who
has intercritical gout simply has gout that has
caused attacks of inflammation in a joint in the
past, but it is not visibly active at the time the
doctor is evaluating the patient.

9. Chronic
Tophaceous Gout
Attacks are frequent
and deposits of tophi
(uric crystals) begin to
collect under the skin.

11. Tophi
Tophi are clumps of urate
crystals that harden under your
skin. They can form on most joints
and cartilage including your
fingers, hands, feet, and/or ankles.
Tophi also commonly form on the
ears. Tophi may not cause pain,
but can damage your joints,
bones, and cartilage if left
untreated.

13. Joint Damage and
Deformity
When you have chronic gout, you
have swelling in your joints
regularly. Chronic inflammation
and tophi can lead to permanent
joint damage, deformity, and
stiffness. In the worst cases of
chronic gout, you may need
surgery to fix joint damage, or
replace joints.

14. Kidney Stones
You are at risk for getting kidney stones
when you have gout, since urate crystals
can build up in your urinary tract and form
stones.

15. Kidney Disease and
Kidney Failure
Kidney stones made from urate
crystals can build up in your
kidneys, and can cause damage
and scars. This kidney
damage from urate crystals is
thought to lead to kidney disease
over time, especially if gout is left
untreated and may lead to
hemodialysis.

16. Psychological
and
Emotional
Problems
Chronic gout causes chronic and
sometimes constant pain. Gout may
affect your ability to walk, work, and
carry out normal tasks. Living with
pain can be emotionally distressing.

17. DIET: Purine Content of
Foods and Beverages

18. LOW: No
Limitation
NON-ALCOHOLIC Beverages,
tea, fruits, breads, grains,
macaroni, cheese, eggs, milk
products, gelatin, cereal
products, sugar, tomatoes &
green vegetables (including
lettuce & excluding vegetables
listed below)

19. MODERATE:
May eat
occasionally
Asparagus, meat, bouillon, chicken, crab, duck,
ham, kidney beans, lentils, lima beans, mushroom,
lobster, oysters, pork, shrimp, spinach, cauliflower,
broccoli, oatmeal

20. HIGH: Best to avoid
ALCOHOLIC Beverages, meat extracts, liver, kidney, pancreas,
brains, anchovies (dilis, bagoong), sardines, herring (tamban,
tawilis, tunsoy, lapad, silinyasis), mackerel (alumahan, hasa-
hasa, tanigue), mussels (tahong), sprout (toge), bacon,
codfish, scallops, trout, haddock, veal, venison, turkey, patis,
yeast, chocolates & nuts

21. THANK YOU!