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GOUT. Why so angry?. “Dino-sores”. Quiz. Metabolic Syndrome X does not include: High Cholesterol (HLD) High Blood Pressure (HTN) High Fat (Obesity) High Sugar (DM) Super Hero Powers. Quiz. Metabolic Syndrome X does not include: High Cholesterol (HLD) High Blood Pressure (HTN)

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Quiz

  • Metabolic Syndrome X does not include:

    • High Cholesterol (HLD)

    • High Blood Pressure (HTN)

    • High Fat (Obesity)

    • High Sugar (DM)

    • Super Hero Powers


Quiz

  • Metabolic Syndrome X does not include:

    • High Cholesterol (HLD)

    • High Blood Pressure (HTN)

    • High Fat (Obesity)

    • High Sugar (DM)

    • Super Hero Powers


Synovial joint anatomy
Synovial Joint Anatomy

  • Synovial fluid – raw egg white

  • Tendon – bone to muscle

  • Ligament – bone to bone



Synovial joint physiology
Synovial Joint Physiology

  • Movement

  • Clean

  • Cartilage


Uric acid

  • Diet

  • Exercise

  • Genetics

Uric Acid


Monosodium urate crystals msu
Monosodium Urate Crystals (MSU)

  • Uric acid > 6.8

  • Temperature


Tophus
Tophus

  • Crystals

  • Surrounded by Immune cells, epithelial cells, fibroblasts


Tophus1
Tophus

  • crystals surrounded by inflammatory reaction



1 asymptomatic hyperuricemia
1. Asymptomatic Hyperuricemia

  • Blood Concentration > 6.8

  • Sometimes leads to Gout


2 acute gouty arthritis
2. Acute Gouty Arthritis

  • First Metatarsal phalangeal (MTP) joint

  • Macrophage response

  • “Inflammation”


Morphology
Morphology

  • Dense neutrophilic infiltrate permeating the synovium and synovial fluid.

  • Long, slender needle-shaped monosodium urate crystals are frequently found in the cytoplasm of the neutrophils as well as in small clusters in the synovium.

  • The synovium is edematous and congested, and contains scattered mononuclear inflammatory cells.

  • When the episode of crystallization abates and the crystals solubilize, the attack remits.


3 intercritical period
3. Intercritical Period

  • Complete remission

  • Medication, diet, exercise

  • Second attack within a couple years


4 chronic tophaceous gouty arthritis
4. Chronic Tophaceous Gouty Arthritis

  • Joint Damage

  • Tophus Formation

  • 10 years later


Morphology1
Morphology

  • Evolves from repetitive precipitation of urate crystals during acute attacks.

  • The urates can heavily encrust the articular surfaces and form visible deposits in the synovium.

  • The synovium becomes hyperplastic, fibrotic, and thickened by inflammatory cells, forming a pannus that destroys the underlying cartilage, and leading to juxtaarticular bone erosions.

  • In severe cases fibrous or bony ankylosis ensues, resulting in loss of joint function.







Summary
Summary

  • Asymptomatic

  • Acute Attack

  • Intercritical Period

  • Chronic Tophaceous Gout


Movies to watch
Movies to watch

  • Gout in blood https://www.youtube.com/watch?v=ymhmqoRR_y8

  • Gout in knee joint https://www.youtube.com/watch?v=vuoBE5uE9y8



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