Gout

Physiotherapy

1. GOUT Dr.Rachita Hada M.P.T Ortho Lecturer CMPP

2. Hypoxanthine-guanine phosphoribosyltransferase ( HGPRT ) is a purine salvage enzyme that plays a key role in the regulation of purine metabolism in man. Phosphoribosyl diphosphate ( PRPP ) is an important intermediate in cellular metabolism.

3. D ifferential diagnosis RA , neoplasm , septic arthritis, infectious arthritis, acute rheumatic fever, juvenile RA, acute fracture, and palindromic rheumatism .

4. Gouty arthritis typically presents with rapid development of severe joint pain, swelling, and tenderness that reaches its maximum within just 6-12 h, especially with overlying erythema , most classically in the first metatarsophalangeal joint . Demonstrating the presence of monosodium urate (MSU) crystals in the joint fluid or tophus has been the gold standard for the diagnosis of gout.

5. Physiotherapy treatment Physical therapy management of gout falls under preferred practice pattern 4E: Impaired joint mobility, motor function, muscle performance, and range of motion associated with localized inflammation . The physical therapist should be aware that any patient with a history of gout, hyperuricemia , and/or a septic joint presentation should be refered for medical evaluation prior to treatment . During acute exacerbations the physical therapist should focus on reinforcement of management program and splinting, orthotics, or other assistive devices to protect the affected joint(s). 

6. Physiotherapy treatment During intercritical phases physical therapists may offer assistance with maintinance of ROM, strength, and function.  The physical therapist can also assist the patient in the creation of a suitable exercise routine and keeping their weight under control. Cryotherapy in the form of crushed ice-packs and other nonthermal modalities may be tried to reduce inflammation and pain.

7. Pseudogout Pseudogout is usually present in the older age group and affects knee and wrist joints. It can be polyarticular with an evidence of calcification of the cartilage ( chondrocalcinosis ). There is deposition of calcium pyrophosphate crystals. The signs and symptoms resemble acute arthritis.

8. The treatment is the same as for gout.