Gout - types,causes,treatment

gout topic include their basic introduction, causes, types, symptoms, types of gout and their treatments

1. Gout
Ravish Yadav

2. INTRODUCTION:
•GOUT is known as the “disease of kings “ and “rich man’s disease”.
•Gout(also known aspodagrawhen it involves the big toe)
•it is amedical condition usually characterized by recurrent attacks of
acuteinflammatory 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
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3. CAUSES
•Hyperuricemiais the underlying cause of gout.
•diet, genetic predisposition, or underexcretion ofurate
•Low uric acid level in blood
•the exact cause is unknown.
•Partly genetic cause in the genes contributing to about 60%
ofvariabilityin uric acid level
•ThreegenesSLC2A9,SLC22A12andABCG2have been found to
commonly be associated with gout, and variations in them can
approximately double the risk
•Loss of function mutations inSLC2A9andSLC22A12cause hereditary
hypouricaemia by reducing urate absorption and unopposed urate
secretion

4. 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

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6. TYPES OF GOUT
•Depending upon the symptoms and severity of disease gout is
classified into
•Acute gout
•Chronic gout
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7. 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.

8. Crystal-induced inflammation
PMN (polymorphonuclear
leukocytes)is critical
component of crystal-
induced inflammation
crystal
deposition
hyperuricemia
protein binding
receptor
binding
cytokine
release
influx of PMN’s
crystals
engulfed
inflammation

9. 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.

10. DIAGNOSTIC TESTS
•Synovial fluid analysis (shows uric acid crystals)
•Uric acid –blood
•BUN (blood urea nitrogen
•Joint x-rays(may be normal)
•Synovial biopsy
•Uric acid –urine
•Creatnine level
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11. BIOCHEMICAL TESTS FOR GOUT:
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12. 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.
•

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14. Monosodium urate crystals
polarized light red compensator
needle shape
negative birefringence

15. Drugs used to treat gout
allopurinol
probenecid
febuxostat?
steroids
NSAID’s
colchicine
Acute Arthritis Drugs Urate Lowering Drugs
rest + analgesia + time

16. TREATMENT
•NSAID,s
•Colchicine
•Uricosuric agents
•Allopurinol
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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.

17. CONTINUED
URICOSURIC AGENTS:
•Probenecid&
Sulfinpyrazone
•They are weak
organic acids
.Sulfinpyrazoneis a
metabolite of
•phenylbutazone.
NSAIDS:
Inhibits pain &
inflammation.
Inhibits uratecrystal
phagocytosis by
decreasing the
migration of
granulocytes into the
inflammatory area.
Indomethacin
ALLOPURINOL
Inhibits synthesis of
uric acid by inhibiting
xanthine oxidase
enzyme
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