GOUT
TAHIRA KHAN
UG-3B
1
INTRODUCTION:
• GOUT is known as the “disease of kings “ and “rich
man’s disease”.
• Gout (also known as podagra when it involves the big
toe)
• it is a medical condition usually characterized by
recurrent attacks of acute inflammatory arthritis-red,
tender, hot, swollen joints
• Gout is a kind of arthritis that occurs when uric acid
builds up in blood and causes joint inflammation.
• Gout effects more men then woman in them occurs
after menopause
http://www.jfootankleres.com/content/pdf
/1757-1146-4-13.pdf
2
CAUSES
•
•
•
•
•
Hyperuricemia is the underlying cause of gout.
diet, genetic predisposition, or underexcretion of urate
Low uric acid level in blood
the exact cause is unknown.
Partly genetic cause in the genes contributing to about
60% of variability in uric acid level
• Three genesSLC2A9, SLC22A12 and ABCG2 have been found
to commonly be associated with gout, and variations in
them can approximately double the risk
• Loss of function mutations in SLC2A9 and SLC22A12 cause
hereditary hypouricaemia by reducing urate absorption and
unopposed urate secretion
www.ncbi.nlm.nih.gov
SYMPTOMS
•
•
•
•
•
•
•
•
•
gouty arthritis
Acute gouty arthritis in big toe(podagra)
Kidney stones
Acute pain in joints
Uric acid crystal depositon in the form of tophi
Tophi in ear lobe, achilles ankle and elbow
Fatigue
Mailase
High uric acid levels
http://www.aafp.org/afp/1999/0215/p925.
html
TYPES OF GOUT
• Depending upon the symptoms and severity
of disease gout is classified into
• Acute gout
• Chronic gout
5
ACUTE GOUT
• Acute gout is a painful condition that typically affects
one joint
• Symptoms usually involve only one or a few joints. The
big toe, knee, or ankle joints are most often affected.
• throbbing, crushing, or excruciating pain
• joint appears warm and red
• fever.
• The attack may go away in a few days, but may return
from time to time. Additional attacks often last longer.
• After a first gouty attack, people will have no
symptoms. Half of patients have another attack.
http://www.aafp.org/afp/1999/0215/p925.
html
CHRONIC GOUT
• Those with chronic arthritis symptoms
include:
• joint damage and
• loss of motion in the joints.
• joint pain and other symptoms most of the
time.
• Tophi below the skin around joints or in other
places. Tophi usually develop only after a
patient has had the disease for many years.
http://www.aafp.org/afp/1999/0215/p925.
html
DIAGNOSTIC TESTS
•
•
•
•
•
•
•
Synovial fluid analyis (shows uric acid crystals)
Uric acid – blood
BUN (blood urea nitrogen
Joint x-rays (may be normal)
Synovial biopsy
Uric acid – urine
Creatnine level
8
BIOCHEMICAL TESTS FOR GOUT:
9
EXAMINATION OF SYNOVIAL FLUID
• ASPIRATION:
• The health care provider uses a needle attached to a
syringe to draw out fluid from the affected joint.
• LAB ANALYSIS:
• The fluid sample is sent to a laboratory for analysis.
Testing can reveal the presence of monosodium
urate (MSU) crystals, which will nearly always
confirm a diagnosis of gout. The laboratory can also
test the sample for infection.
• The procedure itself can cause infection, though this
occurs in less than 0.1% of patients. Aspiration
sometimes eases the patient's symptoms by reducing
swelling and pressure on the tissue surrounding the
http://www.umm.edu/patiented/articles/what_risk_factors_gout_000093_5.htm#ixzz2BBsc1QLS
joint.
TREATMENT
•
•
•
•
NSAID,s
Colchicine
Uricosuric agents
Allopurinol
COLCHICINE
Produces its anti-inflammatory
effects by binding to the intracellular
protein tubulin, preventing its
polymerization leading to the
inhibition of leukocyte migration into
affected area.
Inhibits the synthesis & release of
leukotrienes.
11
CONTINUED
URICOSURIC AGENTS:
NSAIDS:
ALLOPURINOL
• Probenecid &
Sulfinpyrazone
• They are weak
organic acids
.Sulfinpyrazone is a
metabolite of
• phenylbutazone.
Inhibits pain &
inflammation.
Inhibits synthesis of
uric acid by inhibiting
xanthine oxidase
enzyme
Inhibits urate crystal
phagocytosis by
decreasing the
migration of
granulocytes into the
inflammatory area.
Indomethacin
12
13
14