 Definition of Gout
 Pathological classification
 History of Gout
 Gout Aetiology & Pathogenesis
 Clinical management of Gout patients
 Gout is a type of arthritis
 Gout results from an inflammatory response
to build up of Uric acid in blood
 Progresses to Urate crystals in joints
 Urate crystals erode articulating surfaces of
bone
 An inherited metabolic disease
 Acute of Chronic
Acute
Chronic
Sudden Onset
Recurring problem
Short term symptoms
Insufficient resolution
between attacks
Can resolve without
treatment
Can progress to chronic
Gout
Cartilage/bone destruction
results
 Acute Gout
 Chronic Gout
http://www.bpac.org.nz/magazine/2007/septemb
er/gout.asp?page=2
http://www.gout-attack.com/wpcontent/uploads/2011/02/Gout-toeattack.jpg
Discovered in 2640 BC by Egyptians
460-370 BC Hippocrates described Gout as an
acute inflammation of 1st MTP joint
129-200 AD Galen described Tophi. Galen
recognised hereditary nature of Gout
http://kimba63.files.word
m/2011/02/egyptianpyra
.jpg
http://personal.georgiaso
u/~rdanie12/hippocrates
http://www.iep.utm.ed
u/wpcontent/media/galen200x220.jpg
 More likely to
suffer Gout
 Most often affects
 Less likely to
suffer Gout
 Gout appears as radiolucent bone erosions
around joints
 Soft tissue swelling and inflammation present
http://www.bpac.org.nz/magazine/2007/september/imag
xray_bpac.jpg
http://www.learningradiology.com/archives06/COW%20227Gout-elbow/goutelbowcorrect.html
 Gout results from a build up of Uric acid
 Uric acid results from metabolism of Purines
 High blood uric acid levels can be due to a
Purine-rich diet or kidney insufficiency
 The nephron
 Higher incidence of Gout in males as
Oestrogen assists renal clearance of uric acid
 Excess uric acid levels decrease
solubility
 This leads to crystalization
 Urate deposits are covered with
proteins as part of immune
response forming Tophi
 Tophi are the cause of bone
erosion
http://www.hopkinsarthritis.org/wpcontent/uploads/2011/04/gout_fig7.gif
 Treatment is in two stages
 Minimization of the acute inflammation
 Prevention of future attacks
• Acute attacks are managed with drugs. They
last 1-2 weeks
• Chronic conditions are treated by lowering
uric acid levels through exercise, weight loss,
diet changes
 Patient history & physical examination
 Arthrocentesis test
 Blood/Urine analysis
 X-ray studies
Focus will be on
 Family history
 Recent trauma
 Patient’s lifestyle & diet
 Test involves aspirating synovial fluid from
affected joint
 Fluid is examined for urate crystals
 Performed when diagnosing chronic Gout
 Performed to assess uric acid levels when
Gout diagnosis is unclear
 Performed mainly in later stages of Gout
 Patient had pain, swelling, deformities of 1st
MTP joints.
 Swelling around 3rd MCP joint in both hands
 MRT contact with Gout patients is usually in
later stages of disease
 Be mindful positioning as the patient may be
in pain
Anton, F., Garcia, J., Ramos, T., Gonzalez, P., Ordas, J. (1986). Sex Differences in Uric Acid Metabolism in Adults.
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Dalbeth, N. (2006). The Pathway from Gout to Bone Erosion. Retrieved from
http://www.hrc.govt.nz/sites/default/files/HRC69%20(Dalbeth).pdf
Doherty, M. (2009). New Insights into the Epidemiology of Gout. Oxford Rheumatology Journal, 48:ii2–ii8. doi:10.1093
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http://arthritis.about.com/cs/goutdiet/a/goutpurines.htm
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Mandell, B. (2008). Clincal Manifestations of Hyperuricemia and Gout. Cleveland Clinical Journal of Medicine, 75(5).
Retrieved from http://ccjm.org/content/75/Suppl_5/S5.full.pdf
Manno, R. (2012). Clinical Features of Gout. Retrieved from http://www.hopkinsarthritis.org/arthritis-info/gout/clinicalpresentation-of-gout/
Marieb, E., Hoehn, K. (2007). Human Anatomy & Physiology (7th ed.). San Francisco, CA: Pearson Benjamin Cummings
Nuki, G., Simkin, P., (2006). A Concise History of Gout and Hyperuricemia and their Treatment. Journal of Arthritis
Research and Therapy 2006, 8(1), doi:10.1186/ar1906
Stoppler, M. (2012). Gout. Retrieved from http://www.medicinenet.com/gout/page2.htm
Taylor, K. (2012). Uric Acid Crystals. Retrieved from http://www.goutpal.com/uric-acid/uric-acid-crystals/
Teitel, A. (2011). Gout. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001459/
Zare, F., Magnusson, M., Bregstrom, T., Brisslert, M., Josefsson, E., Karlsson, A., Tarkowski, A. (2006). Uric Acid, a
nucleic acid degredation product, down-regulates dsRNA-triggered arthritis. Journal of Leukocyte Biology, 79(3), 4824. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16387838
Rouse Educational
Trust
Pauline Hext