Gout is a form of arthritis caused by high levels of uric acid in the bloodstream. It most commonly affects the big toe joint, causing sudden and severe pain. Gout is caused by an excess production or impaired excretion of uric acid by the kidneys. Uric acid crystallizes and forms needle-like deposits in the joints, triggering inflammation and pain. Treatment involves medications to reduce uric acid levels, relieve pain and inflammation during gout attacks, and prevent future attacks and joint damage from long-term gout. Lifestyle changes like diet modification and exercise can also help lower uric acid levels and prevent gout complications.

1. GOUT
SURYA PRAKASH R
PHARMACY PRACTICE

2. DEFINITION
A Disease That Causes Painful Swelling
In The Places Where Two Bones Fit
Together (Joints) Especially Of The Toes,
Knees And Fingers
Gout is caused by a condition known
as hyperuricemia, where there is too
much uric acid in the body. The body
makes uric acid when it breaks down
purines, which are found in your body
and the foods you eat.

3. FIGURES urate crystals

4. WHAT IS GOUT
Gout Is A Form Of Arthritis Caused By
Excess Uric Acid In The Bloodstream.
The Symptoms Of Gout Are Due To The
Formation Of Uric Acid Crystals In The
Joints And The Body’s Response To Them.
Gout Most Classically Affects The Joint In
The Base Of The Big Toe.
Gout Attacks Often Occur Without
Warning In The Middle Of The Night.
Most Gout Cases Are Treated With
Specific Medications.

5. PATHOLOGY
 An Elevated Serum Urate Level, Together With
Local Factors, Can Result In The Deposition Of
Urate Crystals Into The Joints. Once Crystals
Are Deposited Into A Joint, They Can Be
Released Into The Joint Space And Initiate An
Inflammatory Cascade Causing Acute Gouty
Arthritis. These Acute Flares Resolve, But The
Crystals Remain In The Joint. The Way To
Ultimately Correct The Underlying Metabolic
Problem Of Hyperuricemia And The Crystal
Deposition Is To Lower The Serum Urate Level
And Dissolve The Crystal Deposits. This Will
Stop Both The Acute Attacks And The
Progressive Joint Damage.

6. PATHOPHYSIOLOGY

7. SYMPTOMS
 Gout Usually Becomes Symptomatic
Suddenly Without Warning, Often In The
Middle Of The Night.
 The Main Symptoms Are Intense Joint Pain
That Subsides To Discomfort, Inflammation,
And Redness.
 Gout Frequently Affects The Large Joint Of
The Big Toe, But Can Also Affect The
Forefoot, Ankles, Knees, Elbows, Wrists, And
Fingers.

8. CAUSES
Gout Is Caused Initially By An Excess Of Uric Acid In The
Blood, Or Hyperuricemia.
Uric Acid Is Produced In The Body During The Breakdown
Of Purines – Chemical Compounds That Are Found In High
Amounts In Certain Foods Such As Meat, Poultry, And
Seafood.
Normally, Uric Acid Is Dissolved In The Blood And Is
Excreted From The Body In Urine Via The Kidneys.
 If Too Much Uric Acid Is Produced, Or Not Enough Is
Excreted, It Can Build Up And Form Needle-like Crystals
That Trigger Inflammation And Pain In The Joints And
Surrounding Tissue.

9. ASYMPTOMATIC HYPERURICEMIA
It Is Possible For A Person To Have
Elevated Uric Acid Levels Without Any
Outward Symptoms.
 At This Stage, Treatment Is Not
Required, Though Urate Crystals May
Deposit In Tissue And Cause Slight
Damage.
People With Asymptomatic
Hyperuricemia May Be Advised To Take
Steps To Address Any Possible Factors
Contributing To Uric Acid Build-up.

10. TYPES
Gout Classified Into 4 Stages;
 Asymptomatic Hyperuricemia
 Acute Gout
 Interval (Or) Intercritical Gout
 Chronic Tophaceous gout
 Pseudogout

11. ACUTE GOUT
This stage occurs when the urate crystals
that have been deposited suddenly cause
acute inflammation and intense pain.
This sudden attack is referred to as a
“flare” and will normally subside within 3
to 10 days.
 Flares can sometimes be triggered by
stressful events, alcohol and drugs, as
well as cold weather.

12. INTERVAL (OR)
INTERCRITICAL GOUT
This Stage Is The Period In Between
Attacks Of Acute Gout.
Subsequent Flares May Not Occur For
Months Or Years, Though If Not Treated,
Over Time, They Can Last Longer And
Occur More Frequently.
 During This Interval, Further Urate
Crystals Are Being Deposited In Tissue.

13. CHRONIC TOPHACEOUS GOUT
 Chronic Tophaceous Gout Is The Most Debilitating Type Of Gout.
Permanent Damage May Have Occurred In The Joints And The
Kidneys.
 The Patient Can Suffer From Chronic Arthritis And Develop
Tophi, Big Lumps Of Urate Crystals, In Cooler Areas Of The Body
Such As The Joints Of The Fingers.
 It Takes A Long Time Without Treatment To Reach The Stage Of
Chronic Tophaceous Gout – Around 10 Years.
 It Is Very Unlikely That A Patient Receiving Proper Treatment
Would Progress To This Stage.

15. PSEUDOGOUT
One Condition That Is Easily Confused With Gout Is
Pseudogout.
 The Symptoms Of Pseudogout Are Very Similar To
Those Of Gout, Although Thr Flare-ups Are Usually
Less Severe.
The Major Difference Between Gout And Pseudogout
Is That The Joints Areirritatedby Calcium
Pyrophosphate Crystals Rather Than Urate Crystals.
 Pseudogout Requires Different Treatment To Gout.

16. DIAGNOSIS
Joint Fluid Test
 Your Doctor May Use A Needle To Draw Fluid From Your
Affected Joint. Urate Crystals May Be Visible When The Fluid Is
Examined Under A Microscope.
Blood Test
 Your Doctor May Recommend A Blood Test To Measure The
Levels Of Uric Acid In Your Blood.
Blood Test Results Can Be Misleading, Though. Some People
Have High Uric Acid Levels, But Never Experience Gout.
 And Some People Have Signs And Symptoms Of Gout, But Don't
Have Unusual Levels Of Uric Acid In Their Blood.

17. X-ray imaging
 Joint X-rays can be helpful to rule out
other causes of joint inflammation.
Ultrasound
 This test uses sound waves to
detect urate crystals in joints or in tophi.
Dual-energy computerized tomography (DECT)
 This test combines X-ray images
taken from many different angles to
visualize urate crystals in joints.

18. Medications to treat gout attacks
Nonsteroidal Anti-inflammatory Drugs (Nsaids)
 Nsaids Include Over-the-counter Options Such As Ibuprofen
(Advil, Motrin IB, Others) And Naproxen Sodium (Aleve), As Well As
More-powerful Prescription Nsaids Such As Indomethacin (Indocin,
Tivorbex) Or Celecoxib (Celebrex). Nsaids Carry Risks Of Stomach
Pain, Bleeding And Ulcers

19. Colchicine:
 Your Doctor May Recommend
Colchicine (Colcrys, Gloperba,
Mitigare), An Anti-inflammatory Drug
That Effectively Reduces Gout Pain.
The Drug's Effectiveness May Be
Offset, However, By Side Effects Such
As Nausea, Vomiting And Diarrhea.

20. Corticosteroids
 Corticosteroid Medications,
Such As Prednisone, May Control
Gout Inflammation And Pain.
Corticosteroids May Be In Pill Form,
Or They Can Be Injected Into Your
Joint. Side Effects Of Corticosteroids
May Include Mood Changes,
Increased Blood Sugar Levels And
Elevated Blood Pressure.

21. MEDICATIONS TO PREVENT GOUT
COMPLICATIONS
Medications That Block Uric Acid Production
 Drugs Such As Allopurinol (Aloprim, Lopurin, Zyloprim) And
Febuxostat (Uloric) Help Limit The Amount Of Uric Acid Your Body
Makesside Effects Of Allopurinol Include Fever, Rash, Hepatitis And
Kidney Problems.
 Febuxostat Side Effects Include Rash, Nausea And Reduced Liver
Function.
 Febuxostat Also May Increase The Risk Of Heart-related Death.

22. MEDICATIONS THAT
IMPROVE URIC ACID
REMOVAL
Drugs Such As Probenecid
(Probalan) Help Improve Your
Kidneys' Ability To Remove Uric
Acid From Your Body. Side Effects
Include A Rash, Stomach Pain
And Kidney Stones.

23. RISK FACTORS
 Age And Gender
 Genetics
 Lifestyle Choices: Alcohol Consumption.
 Lead Exposure: Chronic Lead Exposure
 Medications: Some Diuretics And Drugs
Containing Salicylate
 Weight: Being Overweight Increases The Risk
Of Gout
 Recent Trauma Or Surgery
 Other Health Problems: Renal Insufficiency
And Other Kidney Problems
 High Blood Pressure & Diabetes

24. COMPLICATIONS
Kidney Stones:
If Urate Crystals Collect In The Urinary Tract, They Can
Become Kidney Stones.
Recurrent Gout:
Some People Only Ever Have One Flare Up; Others May
Have Regular Recurrences, Causing Gradual Damage To The
Joints And Surrounding Tissue.

25. PREVENTION
maintain a high fluid intake of
around 2 to 4 liters a day
avoid alcohol
maintain a healthy body weight
Excersize regulerly
Maintain healthy diet
Reduce high-purine rich foods
Take Regularly Nuts &whole grains

26. Natural Ways to Reduce Uric Acid in
the Body
Limit Purine-rich Foods.
Avoid Sugar.
Avoid Alcohol.
Lose Weight.
Balance Insulin.
Add Fiber.
Reduce Stress.
Check Medications And Supplements

27. THANK YOU