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Gout

General information

Armina Yaghoot

Table of contents

1. General information

2. Symptoms

3. Risk factors

4. Diagnosis

5. Treatment

6. Sources

General information

Introduction

General information

  • A common form of inflammatory arthritis

  • It is characterized by sudden severe attacks of pain and swelling of joints (often in the middle of the night) --> Flares

  • Mostly affects the joint in the hallux

  • Occurs more often in males than in females

  • In females it is more likely after menopause

https://creakyjoints.org/about-arthritis/gout/gout-treatment/gout-treatment-reduce-uric-acid-crystal-deposits/

Cause

Cause

Hyperuricemia

Cause

Hyperuricemia

Uric acid accumulation in joints

Cause

Hyperuricemia

Formation of monosodium urate crystals

Uric acid accumulation in joints

Cause

Hyperuricemia

Formation of monosodium urate crystals

Uric acid accumulation in joints

Inflammatory response to the crystals

Cause

Hyperuricemia

Formation of monosodium urate crystals

Uric acid accumulation in joints

Acute/chronic gouty arthritis

Inflammatory response to the crystals

Hyperuricemia

Underexcretion of uric acid

Genetic factors

Lactic acidosis

Hyperuricemia

Underexcretion of uric acid

Overproduction of uric acid

Genetic factors

Lactic acidosis

Mutations in the gene for X-linked PRPP synthetase --> increased Vmax

Cause

Pathway

Symptoms

Symptoms

  • Hyperuricemia is typically asymptomatic!

Gout symptoms include:

  • Joint pain

  • Redness

  • Swelling

  • Heat

  • Limited range of motion

https://www.rheumatologyadvisor.com/home/topics/gout/patient-reported-gout-attack-intensity-score-may-be-reliable-for-use-in-clinical-studies/

Risk factors

Risk factors

  • Obesity

  • Diabetes

  • Hypertension

  • Alcoholism

  • Abnormal kidney function

  • Diet high in fructose and purines

Food

Purine-rich foods

Red meat

Purine-rich foods

Red meat

Organ meats

Purine-rich foods

Red meat

Organ meats

Purine-rich foods

Animal proteins

Red meat

Organ meats

Purine-rich foods

Animal proteins

Seafood

Diagnosis

  • Joint fluid test
  • Blood test
  • X-ray imaging
  • Ultrasound
  • Dual-energy computerized tomography (DECT)

Treatment

THE PROBLEM

Treatment

There is no cure!

Acute attacks: Anti- inflammatory agents

Colchicine --> Prevents formation of microtubules

Uricosuric agents eg. probenecid or sulfinpyrazone --> Increase renal excretion of uric acid

Allopurinol --> Inhibition of uric acid synthesis (xanthine oxidase)

Sources

Lippincott page 299ff.

Lecture slides

https://www.cdc.gov/arthritis/basics/gout.html

https://www.mayoclinic.org/diseases-conditions/gout/diagnosis-treatment/drc-20372903

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