GOUT
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GOUT. TAHIRA KHAN UG-3B. 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 )

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Gout

GOUT

TAHIRA KHAN

UG-3B


Introduction

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


Causes

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

  • ThreegenesSLC2A9, 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

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

TYPES OF GOUT

  • Depending upon the symptoms and severity of disease gout is classified into

  • Acute gout

  • Chronic gout


Acute gout

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

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

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

  • Creatninelevel


Biochemical tests for gout

BIOCHEMICAL TESTS FOR GOUT:


Examination of synovial fluid

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 joint.

http://www.umm.edu/patiented/articles/what_risk_factors_gout_000093_5.htm#ixzz2BBsc1QLS


Treatment

TREATMENT

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.

  • NSAID,s

  • Colchicine

  • Uricosuricagents

  • Allopurinol


Continued

CONTINUED


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