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Gout

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Gout

  1. 1. GOUT The Disease Of Kings Presented By Sriloy Mohanty B.N.Y.S S-VYASA University
  2. 2. Contents… Introduction Definition Epidemiology Symptoms Causes Risk factors Diagnostic procedure Treatment protocol Treatment by natural modalities Research articles 2 sriloy21@gmail.com
  3. 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 3 sriloy21@gmail.com
  4. 4. Definition It can be defined as the pathological reaction of the joint or periarticular tissues to the presence of monosodium urate monohydrate crystals 4 sriloy21@gmail.com
  5. 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. 5 sriloy21@gmail.com
  6. 6. The Four Stages of Gout • Asymptomatic • Acute • Intercritical • Chronic 6 sriloy21@gmail.com
  7. 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 7 sriloy21@gmail.com
  8. 8. ACUTE • Sever and sudden onset • Involve one or a few joints • Frequently starts nocturnally • Joint is warm, red, and tender 8 sriloy21@gmail.com
  9. 9. INTERCRITICAL • More concentration of uric acid crystals • Typically no need for drug intervention at the time. 9 sriloy21@gmail.com
  10. 10. CHRONIC • Continuous or persistent over a long period of time • Treatment required • Not easily or quickly resolved 10 sriloy21@gmail.com
  11. 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 11 sriloy21@gmail.com
  12. 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 12 sriloy21@gmail.com
  13. 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. 13 sriloy21@gmail.com
  14. 14. Risk factors • Males after the age of 20 • Female after menopause • High BMI • Diet rich in seafood • HTN • Thiazide diuretics • Excess alcohol use 14 sriloy21@gmail.com
  15. 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 15 sriloy21@gmail.com
  16. 16. 16 sriloy21@gmail.com
  17. 17. Complications Joint deformity Osteoarthritis Tophi may produce draining sinuses that may become infected Renal stones, pyelonephritis, obstructive renal disease 17 sriloy21@gmail.com
  18. 18. Tophi-(Solid urate deposits in tissues) Gross appearance of tophi X-ray view of a tophi 18 sriloy21@gmail.com
  19. 19. Diagnosis History & physical examination Clinical symptoms alone are sufficient to make accurate DX in most cases Family history of gout Diagnostic studies 19 sriloy21@gmail.com
  20. 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 20 sriloy21@gmail.com
  21. 21. SYNOVIAL FLUID ANALYSIS (Polarized Light Microscopy) The Gold standard Crystals intracellular during attacks Needle & rod shapes 21 sriloy21@gmail.com
  22. 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 22 sriloy21@gmail.com
  23. 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 23 sriloy21@gmail.com
  24. 24. Dietary measures Weight reduction Avoidance of alcohol more low-fat dairy products Avoidance of foods high in purines 24 sriloy21@gmail.com 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. 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 25 sriloy21@gmail.com
  26. 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. 26 sriloy21@gmail.com
  27. 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 27 sriloy21@gmail.com
  28. 28. Thank You
  29. 29. 29 sriloy21@gmail.com

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