Gout: A Medical Overview PDF
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Uploaded by InterestingWilliamsite
University of Basrah, College of Medicine
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Summary
This document provides an overview of gout, a type of inflammatory arthritis. It details the causes, symptoms, diagnosis, and potential treatments for gout. The information aims to educate readers on the basics of this common condition.
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**GOUT** **Definition** - Gout is a type of microcrystal synovitis caused by monosodium urate crystal deposition in joints due to abnormal uric acid metabolism. - Chronic disease leads to tophi (skin deposits) and potential urate stone formation in the urinary tract. **Epidemiology**...
**GOUT** **Definition** - Gout is a type of microcrystal synovitis caused by monosodium urate crystal deposition in joints due to abnormal uric acid metabolism. - Chronic disease leads to tophi (skin deposits) and potential urate stone formation in the urinary tract. **Epidemiology** - Most common inflammatory arthritis in men and post-menopausal women. - Rare in pre-menopausal women due to estrogen-enhanced uric acid excretion. - Incidence has increased with rising obesity and metabolic syndrome. **Causes** 1. **Decreased Uric Acid Excretion** (90% cases): - Renal failure, lactic acidosis, lead poisoning, alcohol, and drugs (e.g., thiazides, loop diuretics, aspirin). 2. **Increased Uric Acid Production**: - Conditions like myeloproliferative disorders, psoriasis, and high-purine diets. 3. **Dietary Intake**: - Red meat, shellfish, high fructose. 4. **Metabolic Syndrome**: - Obesity, diabetes, hypertension, dyslipidemia. **Pathophysiology** - Uric acid levels are influenced by dietary purines and endogenous metabolism. - Xanthine oxidase is key in converting hypoxanthine → xanthine → uric acid. - Imbalance in synthesis and excretion causes crystal deposition in joints. **Clinical Features** 1. **Acute Gout**: - **Classic Presentation**: Painful monoarthritis, most commonly affecting the 1st metatarsophalangeal joint (podagra). - Features: Severe pain, tenderness, swelling, redness, and warmth. - Typically worsens in the early morning; self-limiting in 5--14 days. 2. **Chronic Gout**: - Joint deformities, asymmetrical arthritis, functional impairment. - **Tophi**: Nodules on extensor surfaces (e.g., hands, elbows), which may ulcerate. - Renal complications: Stones, interstitial nephritis. **Investigations** 1. **Serum Uric Acid**: May be normal during acute attacks. 2. **Joint Fluid Analysis**: - Diagnostic: Needle-shaped monosodium urate crystals. 3. **Imaging**: - Acute: Normal X-ray. - Chronic: Erosions and punched-out lesions on X-ray. 4. **Other Tests**: - CBC, ESR, CRP, renal function, lipid profile. **Treatment** 1. **Acute Gout**: - **First-line**: Colchicine (0.5mg 2--4 times/day). - NSAIDs and corticosteroids (oral or IM methylprednisolone) are alternatives. - Ice packs and joint aspiration for symptom relief. - Biologic agents (e.g., anakinra) in resistant cases. 2. **Chronic Gout**: - Lifestyle modifications: Reduce alcohol, weight loss, limit purine-rich foods. - **Urate-Lowering Therapy**: - Allopurinol (first choice, xanthine oxidase inhibitor). - Febuxostat for those intolerant to allopurinol. - **Uricosuric Drugs**: Probenecid (avoided in renal impairment).