Information of gout | gout

Information of gout | gout

Gout is inflammatory arthritis associated with hyperuricemia resulting from the deposition of monosodium urate crystals in joints, tendons, and surrounding tissue where they occur inflammation.

Gout is traditionally divided into primary and secondary forms, accounting for about 90% and 10% of cases respectively.

The term primary gout is used to designate cases in which the basic cause is unknown or less commonly when the cause is on in-born metabolic abnormality characterized primarily by hyperuricemia and gout.

In the remaining cases, termed secondary the hyperuricemia is known but gout is not the main or dominant clinical disorder.

Gout Clinical features

Gout is more common in men than in women & does not usually cause symptoms before the age of 30.

Four stages in the evolution of gout namely

1)Asymptomatic hyperuricemia

2)Acute gout- arthritis

3)”Intercritical” gout

4)Chronic tophaceous gout

Acute gout arthritis is manifested by local pain which often involves a single joint in the early stages of the disease but may subsequently become polyarticular.

Although any joint may be involved the following joints in order of frequency are affected: great too (90% of patients ) ankles, heel & wrist.

In most cases, the pain is abrupt & intense.

The initial acute attacks usually resolve completely & are followed by an asymptomatic interval (intercritical gout).

In the absence of treatment, recurrent episodes of arthritis involve ↑ a number of joints & eventually lead to a permanent joint deformity.

In severe cases, significant additional soft tissue deformity.

Curiously, the tophi themselves are usually painless, despite the tendency of advanced lesions to ulcerate.

Urate renal stones may cause destructive nephropathy.

More chronic disease is associated with recurrent episodes of pyelonephritis and eventually chronic renal failure.

Gout Diagnostic criteria

Two of the following criteria required for clinical diagnosis

1)Clear h/o at least 2 attacks painful joint swelling with complete resolution within 2 weeks.

2)Clear history/observation of podagra.

3) Presence of tophus.

4)Rapid response to colchicine within 48 hours of treatment initiation.

 

Definitive diagnosis: Presence of monosodium urate crystals seen in synovial fluid/tissues.

Management

Acute attack

Colchicine produces a dramatic anti-inflammatory effect with relief within 24-48 hours.

NSAIDs for additional pain relief.

Corticosteroids (Po or intraarticular)

Adrenocorticotropic hormone (ACTH)

Joint aspiration to decompress.

Collaborative care

Prevention of acute attack

Colchicine combined with

Allopurinol ( Zyloprim, Aloprim ) block the production of uric acid

Probenecid (Benemid)

sulfinpyrazone ( Anturane ) – inhibit tubular reabsorption of uric acid

Febuxostat (uloric ) – inhibit xanthine oxidase, recently shown to reduce serum uric acid level.