Gout

1. GOUT The Disease Of Kings Presented By Sriloy Mohanty B.N.Y.S S-VYASA University

2. Contents… Introduction Definition Epidemiology Symptoms Causes Risk factors Diagnostic procedure Treatment protocol Treatment by natural modalities Research articles 2 [email protected]

3. Introduction Gout comes from Latin gutta and old French gote meaning "a drop." Several hundred years ago gout was thought to be caused by drops of viscous humors that seeped from blood into the joints Gouty arthritis in one or more joints (but less than four) May be precipitated by trauma, surgery, alcohol ingestion, or infection 3 [email protected]

4. Definition It can be defined as the pathological reaction of the joint or periarticular tissues to the presence of monosodium urate monohydrate crystals 4 [email protected]

5. Epidemiology About 10% of people with hyperuricemia develop gout at some point in their lifetimes Depending on the degree of hyperuricemia When levels are between 415 and 530  μmol /l (7 and 8.9 mg/dl), the risk is 0.5% per year while in those with a level greater than 535 μmol/l (9 mg/dL), the risk is 4.5% per year. 5 [email protected]

6. The Four Stages of Gout Asymptomatic Acute Intercritical Chronic 6 [email protected]

7. ASYMPTOMATIC A- meaning without indicates that there are no symptoms associated Patient will be unaware of what is happening Gout can only be determined with the help of a physician 7 [email protected]

8. ACUTE Sever and sudden onset Involve one or a few joints Frequently starts nocturnally Joint is warm, red, and tender 8 [email protected]

9. INTERCRITICAL More concentration of uric acid crystals Typically no need for drug intervention at the time. 9 [email protected]

10. CHRONIC Continuous or persistent over a long period of time Treatment required Not easily or quickly resolved 10 [email protected]

11. Clinical Manifestations Onset usually nocturnal, with sudden swelling and excruciating pain Joint pain usually begins over 2–4 hours and during the night May have low grade fever Usually subsides within 2-10 days Joints are normal, with no symptoms between attacks 11 [email protected]

12. Other Symptoms the heels, knees, wrists, and fingers, may also be affected The reason for onset at night is due to the lower body temperature Other symptoms may rarely occur along with the joint pain, including fatigue and a high fever 12 [email protected]

13. Causes Diet Genetic predisposition ( SLC2A9 ,  SLC22A12 , and  ABCG2 ) Under excretion of urate (90%) The salts of uric acid Insulin resistance Regular aspirin and niacin use THE MAIN CAUSE IS THE IMBALANCE BETWEEN THE INTAKE AND EXCREATION. 13 [email protected]

14. Risk factors Males after the age of 20 Female after menopause High BMI Diet rich in seafood HTN Thiazide diuretics Excess alcohol use 14 [email protected]

15. Pathophysiology Uric acid is end product of purine metabolism and is excreted by the kidneys Hyperuricemia Diet high in purines will not cause gout, but may trigger an attack in a susceptible person 15 [email protected]

16. 16 [email protected]

17. Complications Joint deformity Osteoarthritis Tophi may produce draining sinuses that may become infected Renal stones, pyelonephritis, obstructive renal disease 17 [email protected]

18. Tophi-( Solid urate deposits in tissues ) Gross appearance of tophi X-ray view of a tophi 18 [email protected]

19. Diagnosis History & physical examination Clinical symptoms alone are sufficient to make accurate DX in most cases Family history of gout Diagnostic studies 19 [email protected]

20. Diagnostic Studies Serum uric acid levels 420 μmol/l (7.0 mg/dl) in males and 360 μmol/l (6.0 mg/dl) in females WBC elevated during acute attack ESR 24 hour urine uric acid levels Synovial fluid aspiration contains uric acid crystals Seldom necessary X-rays appear normal in early stages; tophi appear as eroded areas of bone 20 [email protected]

21. SYNOVIAL FLUID ANALYSIS (Polarized Light Microscopy) The Gold standard Crystals intracellular during attacks Needle & rod shapes 21 [email protected]

22. Treatment protocol Acute attack Colchicines produces dramatic anti-inflammatory effects with relief within 24-48 hours NSAIDs for additional pain relief Corticosteroids (intra-articular) Adrenocorticotropic hormone (ACTH) Joint aspiration to decompress 22 [email protected]

23. Prevention of acute attacks Colchicine combined with: Allopurinol (zyloprim, alloprim) – blocks production of uric acid Probenecid (benemid), sulfinpyrazone (anturane) – inhibit tubular reabsorption of uric acid Febuxostat ( uloric ) – inhibits xanthine oxidase , recently shown to reduce serum uric acid levels 23 [email protected]

24. Dietary measures Weight reduction Avoidance of alcohol more low-fat dairy products Avoidance of foods high in purines High: mussels, liver, kidney, meat soups, sweetbreads, beer & wine Moderate: Chicken, salmon, crab, mutton, pork, beef, ham Vitamin C intake of 1,500 mg per day decreases the risk of gout by 45% Coffee, but not tea, consumption is associated with a lower risk of gout 24 [email protected]

25. What we can eat without fear Bread (white) and crackers Butter or margarine (in moderation) Cake and cookies Carbonated beverages Cereals Cheese Chocolate Coffee Cream (in moderation) Custard Eggs Fats (in moderation) Fruit Gelatin desserts Herbs Ice cream Milk Noodles Nuts Oil Olives Pickles Pasta Popcorn Puddings Relishes Rice Salt Sugar and sweets Tea Vegetables (except those mentioned in the first group) Vinegar 25 [email protected]

26. Home remedy Raise and rest your limb Use a splint to immobilize the joint Do not do vigorous exercise apply an ice pack or bag of frozen vegetables wrapped in a towel Do not cover the joint. 26 [email protected]

27. Acupuncture Sedative points- gv-20, Homeostasis point- Li-11 Analgesic point- st-44 Immune mechanism- Du-14, Sp-6, St-36 Influential point-UB-17, UB-11 Point for Pruritis-Sp-10,UB-16 Some local points 27 [email protected]

28. Thank You

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