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1. Gout
Mearag ElBadri

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Gout is a type of inflammatory arthritis (sometimes called
gouty arthritis) that develops in people who have high
levels of uric acid in their body. Uric acid is produced
naturally by the body and from eating foods that have
purines. Purines are substances in animal and plant foods
that the body converts to uric acid. Normally, the kidneys
remove this acid from the blood and it leaves the body
through the urine. With gout, excess uric acid builds up
in the joints and forms needle-like crystals that cause
extreme pain.

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A gout attack can also be caused by joint injury,
infec tion, kidney problems, medications or diet
habits (e.g. a purine-rich, sugary diet, drinking
too much alcohol or not enough water).
Being overweight, having a family history of
gout or having untreated high blood pressure,
diabetes or metabolic syndrome also increases
the risk of developing gout

4. Areas of the body that can be
affected by gout include:
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Joints.
Bursae, cushion-like sacs between bones and
other soft tissues.
Tendon sheaths, membranes that surround
tendons.
Kidneys, because the high uric acid levels can
lead to stones.

5. Symptoms of Gout
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Gout attacks usually come on suddenly. You
may go to bed feeling fine but wake up with
extreme joint pain.
The first gout attack usually occurs in the large
joint of the big toe.
However, other joints and areas around the
joints can be affected, like foot arches (insteps)
, ankles, heels and knees

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Common symptoms include
swelling
, stiffness,
tenderness,
warmth and redness in and around joints.
The pain may last hours or weeks.
The build-up of uric acid can look and feel like
lumps under the skin (tophi).
It can also collect in the kidneys and cause
small, hard
deposits (kidney stones).

7. Stages of gout
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(1) Asymptomatic hyperuricemia,
(2) Acute gouty arthritis
(3) Intercritical gout.
(4) Chronic tophaceous gout.

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Asymptomatic hyperuricemia appears
around puberty in males and after menopause
in women.

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Acute arthritis:-
- Appears in the form of sudden onset of joint pain
associated with localized erythema and warmth;
constitutional symptoms are uncommon, except
mild fever.
- The vast majority of first attacks are
monarticular; 50% occur in the first
metatarsophalangeal joint (great toe), and 90% in
the , ankle, heal, or wrist.Acute gouty arthritis may
last for hours to weeks, but it gradually completely
resolves and the patient enters an asymptomatic

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intercritical period.
In the absence of appropriate therapy, the
attacks recur at shorter intervals and frequently
become polyarticular.
After a decade , symptoms fail to resolve
completely after each attack, and the disease
progresses to

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chronic tophaceous gout.
At this stage, radiographs show
characteristic articular bone erosion caused by
the crystal deposits and loss of the joint space.

12. • Renal manifestations of gout can appear as
renal colic associated with the passage of
stones, and can evolve into chronic gouty
nephropathy.

13. Diagnosing Gout
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medical history, including:
Your symptoms.
Any risk factors you have.
Any medications you have taken.
Examine the affected joints.
Order a laboratory test to check urate levels in your blood.
Take a sample of fluid from one of your painful joints, a
swollen bursae (fluid-filled sac that cushions the joint), or a
tophus to look for urate crystals using a special microscope.
Order an ultrasound or special CT scan to check for urate
crystal buildup in the affected joint as well as to diagnose
other conditions that may be causing the symptoms.

14. Treating Gout
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The main goals of gout treatment are to:
•Peevent uric acid buildup.
•Reduce inflammation that can affect joints
and organs.

15. Medication
Prescription medications can help lower uric acid to prevent
gout attacks and keep the condition from becoming chronic.
Other medications may be used to treat inflammation and pain.

Allopurinol.
Benzbromarone.
Colchicine.
Febuxostat.
Lesinurad.
Pegloticase.
Probenecid.
Rasburicase

16. Physical Activity and Weight
Management.

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Participating in regular physical activity and
maintaining a healthy weight can lower your
risk of repeated gout attacks, as well as the
chances of developing heart disease, which is
common in people with gout.

17. Diet :
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Eating a healthy diet rich in vegetables, whole
grains, plant proteins ( e.g., beans, lentils, peas),
healthy fats (e.g., nuts, extra-virgin olive oil) and
minimally
processed foods may reduce your risk of a
gout attack.
Eliminating or minimizing purine-rich meats/
seafoods and watching alcohol intake can help
lessen uric acid levels in the body and limit
acute gout flares.