what is gout
the build up of uric acid crystals in the joints
what are the stages of gout
- asymptomatic
- acute gout - pain, swelling, redness and spontaneous resolutions over 7 to 10 days
- chronic gout
- intermittent gout
- tophaceous gout - this is characterised by polyarticular attacks, progressive joint destruction, urate crystals in soft tissue and joints (tophi)
what illness can make people get gout
- LESCH NYHAM syndrome- over production of uric acid
- RENAL FAILURE - under excretion of the uric acid
- LEAD TOXICITY
- DRUGS
- IDIOPATHIC FACTORS
what are some predispositional factors to give someone gout
- gender (men)
- family history
- body size
- diet (purine rich foods)
- alcohol consumption
- diuretic use
- reno impairment
Inflammation in Gout:
Develops from hyperuricemia with uric acid crystals
Uric acid crystals stimulate:
Inflammatory signals
Activation of complement
Chemoattraction of neutrophils
Cytokines involved: IL-1, IL-6, TNF-α
Inflammasome, especially IL-1, implicated in gout onset
investigations for gout
Joint aspiration and polarized light microscopy for crystal detection
FBC: Raised WBC
ESR: Raised
X-ray: Normal in acute gout
Serum uric acid levels elevated (>10mg/L), but high levels don’t necessarily mean gout
Gout and Underlying Health Conditions:
Linked to conditions like hypertriglyceridemia, low HDL cholesterol, insulin resistance, obesity, hypertension
Gout-like symptoms can serve as a screening tool for underlying health problems
Treatment of Acute Gout Attacks:
Aims to reduce symptoms
Commonly used: NSAIDs, colchicine, prednisolone
NSAIDs at high doses (except aspirin)
Colchicine
Alkaloid preventing and relieving acute gout attacks
Blocks neutrophil migration, inflammatory glycoprotein production
Side effects: Gastrointestinal symptoms, toxicity at high doses
long term control of gout
Involves lifestyle changes and drug therapy
Common drugs: Xanthine oxidase inhibitors (allopurinol, febuxostat), uricosuric agents
Drug therapy not started during an attack but after settling
Allopurinol:
Allopurinol:
Drug of choice for long-term gout treatment
Reduces uric acid synthesis by inhibiting xanthine oxidase
Side effects: Mainly gastrointestinal, rare Stevens-Johnson syndrome
Not effective for acute attacks
Febuxostat:
Febuxostat:
Another xanthine oxidase inhibitor reducing uric acid levels
Side effects: Gastrointestinal symptoms, joint stiffness, headaches
Contraindicated with some chemotherapeutic drugs, costly
Other Gout Treatment Options:
Other Gout Treatment Options:
Uricosuric agents (sulfinpyrazone, benzbromarone)
Block uric acid reabsorption, increase excretion in urine
Biologics (canakinumab)
Target IL-1β pathways and P2X7 receptors
