Gout and Gouty Arthritis
Gout definition
Gout meaning-
Gout is disorder of purine metabolism manifested by the following feature occurring singl or in combination -
1.increased serum uric acid concentration (hyperuricemia)
2.Recurrent attacks of characteristic type of acute Arthritis in which crystals of monosodium urate monohydrate maybe demonstrable in the leukocytes present in Synovial fluid.
3.Aggregated deposits of monosodium urate monohydrate toffi in and around the joints of the extremities.
4.Renal disease involving interstitial tissue and blood vessels.
5.Uric acid nephrolithiasis.
The disease usually begins in third decade of life and effect men more often than women.
A family history of gout is present in a fairly large proportion of cases indicating role of inheritance in hyperuricemia.
Clinically the natural history of gout comprises four stages : asymptomatic hyperuricemia, acute gouty Arthritis, asymptomatic intervals of intercritical periods and chronic tophaecious stage.
treatment for gout
Proper diet
Say no to coffee aan tea
Exercise
Febuxostat
Uricosurics
symptoms of gout
Intense pain
Constitutional symptom like fever
Tophi - Deposition of urate crystals
Bone erosions
Inflammation
Problem in Movement
pictures of gout
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| Gout tophi |
Gout medicine
Febuxostat
Sulfunpyrazone
Probenecid
Uricosurics
gout diet
Coffee ,Tea is prohibited as they contain nucleotides.
Gout causes
1.increased serum uric acid concentration (hyperuricemia)
2.Recurrent attacks of characteristic type of acute Arthritis in which crystals of monosodium urate monohydrate maybe demonstrable in the leukocytes present in Synovial fluid.
3.Aggregated deposits of monosodium urate monohydrate toffi in and around the joints of the extremities.
4.Renal disease involving interstitial tissue and blood vessels.
5.Uric acid nephrolithiasis.
Types of gout
Pathogenesis of gout-
The fundamental biochemical Hallmark of gout is hyperuricemia, a serum uric acid level in excess of 7mg/dl which represents the upper limit of solubility of monosodium urate in serum at 37 degree Celsius at blood pH is associated with increased risk of development of gout. Thus pathogenesis of gout is pathogenesis of hyperuricemia.
Hyperuricemia and gout may be classified into two types -
Metabolic and Renal, each of which may be primary or secondary.
Hyperuricemia of metabolic origin this group comprises about 10% cases of gout which are characterized by overproduction of uric acid, there is either an accelerated rate of purine biosynthesis de novo or an increased turn over of nucleic acids.
The causes of primary metabolic gout include a number of specific enzyme defects in purine metabolism which may be either of unknown cause for inborn error of metabolism.
The secondary metabolic gout is due to either increased purine biosynthesis or deficiency of enzyme glucose-6-phosphatase.
Hyperuricemia of renal origin about 90% cases of gout are the result of reduced renal excretion of uric acid, renal excretion could be due to reduced glomerular filtration of uric acid and harms to tubular reabsorption or decreased secretion.
The causes of gout of renal origin include diuretic therapy, drug-induced, adrenal insufficiency, starvation, diabetic, ketosis and disorder of parathyroid and thyroid.
Acute Gouty Arthritis
This stage is characterized by acute synovitis triggered by precipitation of sufficient amount of needle shaped crystals of monosodium urate from serum or synovial fluid.
There is joint effusion containing numerous polymorphs, macrophages and microcrystals of urates. The mechanism of acute inflammation appears to include phagocytosis of crystals by leukocyte activation of Kallikrein system, activation of the complement system and urate mediated desruption of lysosomes.
Acute gouty Arthritis is predominantly disease of lower extremities affecting most commonly great toe ,joint affected in order of decreasing frequency are the instep, ankles, Heels, knees, wrists.
Chronic tophaceous Arthritis
Recurrent attacks of acute gouty Arthritis lead to progressive evolution in to chronic Arthritis, the deposit of urate encrushed the articular cartilage, there is a synovial proliferation, pannus formation and progressive destruction of articular cartilage and subchondral bone.
Tophi in soft tissues - A Tophi is a mass of Urates measuring a few millimetres to a few centimetres in diameter. Tophi may be located in the particular tissues as well as subcutaneously such as on the hands and feet.
Acute urate nephropathy
Chronic urate nephropathy
Uric acid nephrolithiasis
Other Questions -
What is the main cause of gout?
Described above
How is uric acid tested?
Blood sample diagnosis
What is the best way to get rid of gout?
Proper diet , exercise ,Medicines.
What foods cause gout?
No any food cause gout.
What foods get rid of gout?
Fruit
Vegetable
Low fat diet
Rice,grain
No coffee and tea
What will happen if you have high uric acid?
Described above in symptoms of gout
What is the normal range of uric acid?
2.4-6.0 mg/dl (female)
3.4-7.0mg/dl (male)
When should uric acid test be done?
Early morning blood sample with overnight fasting
Or 24 hour Urine collection
