GOUT Flashcards
most common inflammatory and
metabolic joint disorder which is caused by the deposition of monosodium urate crystals in joints and soft tissues following chronic hyperuricaemia.
Gout
Acute sudden inflammation of the joint caused by___________ concentration in the blood leading to the development of tophi( Tophus)
high level of uric acid
Normal Uric acid levels
Male
Female
2.4-6.0 mg/dL
(female) and 3.4-7.0 mg/dL (male).
Uric acid deposition is called
Tophi ( tophus)
It is called ___ which means gout of the foot, especially the big toe. It is also called ‘foot trap’, is gout which affects the joint located between the foot and the big toe,
known as the metatarsophalangeal joint
Podagra
joint located between the foot and the big toe
metatarsophalangeal joint
ETIOLOGY of GOUT
Purine rich foods-
● Meat
• Kidney
• Liver
• Seafood
• Certain vegetables[peas, beans, cauliflower]
• Caffeine
● Drugs [loop diuretics, Chemo, salicylates
corticosteroids]
2 types of gout
Primary
Secondary
a hereditary error of
purine metabolism leads to the
overproduction or retention of uric acid
PRIMARY GOUT
gout may be related to another
acquired disorder or may be the result of
drugs known to inhibit uric acid excretion.
SECONDARY GOUT
4 STAGES OF GOUT
ASYMPTOMATIC
ACUTE
INTERCRITICAL
CHRONIC
No symptoms
● Only by physical examination/ diagnostic
studies
● Uric acid Level: 7-8 mg/dl
ASYMPTOMATIC
Severe and sudden onset
● Only one or two joints will be involved
● Symptoms will appear usually at the night
time
● Joints will be warm, red, oedematous, pain
and tender
● increase in uric acid level (8-12mg/dl)
ACUTE STAGE
refers to the asymptomatic period between
attacks of acute gouty arthritis, where the patient
experiences no joint pain or swelling, but
hyperuricemia and crystal deposition continue.
INTERCRITICAL STAGE
Continuous and persistent pain
● Decrease in the mobility of joints
● Increase in redness and edema
● Difficulty to treat with medicine
● Uric acid level: >15 mg/dl
CHRONIC STAGE
COMPLICATIONS OF GOUT
Severe degenerative arthritis
Urate Nephropathy
Renal failure
Renal calculi
Fracture
Infections
DIAGNOSTIC
History and physical examination
● Family history of gout
● Blood test-
● Elevated serum uric acid levels
● Urine test-
● Elevated 24-hr urine for uric acid levels
● X-ray
● Presence of sodium urate crystals in synovial fluid
MANAGEMENT (DRUG THERAPY)
Ibuprofen –400mg NSAIDS
Corticosteroids (prednisone)—1-2mg/kg
Probenecid—500mg
Allopurinol —300mg
Colchicine –500mcg
Adrenocorticotropic hormone (ACTH) - 40 IU
Drug that increases uric acid excretion in the urine
Probenecid
a purine analog decreases uric acid formation and may also inhibit purine synthesis.
Allopurinol
interrupts urate crystal deposition in joint
tissues.
Colchicine
helps to reduce the gout inflammation
Adrenocorticotropic hormone (ACTH)
FOODS TO BE AVOIDED
Alcohol
• Red meat and organ meat such as liver or
kidneys
• Seafood
• Certain vegetables[peas, beans, cauliflower]
• Caffeine
• Sugary drinks and foods high in fructose
• Processed foods and refined carbohydrates
