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    Dhaneshwar Prasad Yadav Junior Intern

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    Janak Kc
    Gout is a metabolic disease that causes episodic acute arthritis or chronic arthritis. It results from increased uric acid levels (hyperuricemia) in the body. The most common early manifestation is acute arthritis affecting a single joint, typically the big toe. Chronic gout can lead to involvement of multiple joints and deposits of urate crystals. Diagnosis is confirmed by identifying urate crystals in joint fluid. Treatment involves medications like NSAIDs, colchicines, or steroids for acute attacks, and long-term urate-lowering drugs like allopurinol or febuxostat to prevent future attacks.

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    Dhaneshwar Prasad Yadav Junior Intern

    Uploaded by

    Janak Kc
    23 views15 pages
    Gout is a metabolic disease that causes episodic acute arthritis or chronic arthritis. It results from increased uric acid levels (hyperuricemia) in the body. The most common early manifestation is acute arthritis affecting a single joint, typically the big toe. Chronic gout can lead to involvement of multiple joints and deposits of urate crystals. Diagnosis is confirmed by identifying urate crystals in joint fluid. Treatment involves medications like NSAIDs, colchicines, or steroids for acute attacks, and long-term urate-lowering drugs like allopurinol or febuxostat to prevent future attacks.

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    Gout is a metabolic disease that causes episodic acute arthritis or chronic arthritis. It results from increased uric acid levels (hyperuricemia) in the body. The most common early manifestation is acute arthritis affecting a single joint, typically the big toe. Chronic gout can lead to involvement of multiple joints and deposits of urate crystals. Diagnosis is confirmed by identifying urate crystals in joint fluid. Treatment involves medications like NSAIDs, colchicines, or steroids for acute attacks, and long-term urate-lowering drugs like allopurinol or febuxostat to prevent future attacks.

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    23 views15 pages

    Dhaneshwar Prasad Yadav Junior Intern

    Uploaded by

    Janak Kc
    Gout is a metabolic disease that causes episodic acute arthritis or chronic arthritis. It results from increased uric acid levels (hyperuricemia) in the body. The most common early manifestation is acute arthritis affecting a single joint, typically the big toe. Chronic gout can lead to involvement of multiple joints and deposits of urate crystals. Diagnosis is confirmed by identifying urate crystals in joint fluid. Treatment involves medications like NSAIDs, colchicines, or steroids for acute attacks, and long-term urate-lowering drugs like allopurinol or febuxostat to prevent future attacks.

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    Gout

    Dhaneshwar Prasad Yadav


    Junior Intern
    Introduction
     Gout is a metabolic disease that most often affects middle-aged to
    elderly men and postmenopausal women.

     It results from an increased body pool of urate with hyperuricemia.

     It typically is characterized by episodic acute arthritis or chronic


    arthritis
    Acute arthritis
     Acute arthritis is the most common early clinical manifestation of
    gout.

     Usually, only one joint is affected initially, but polyarticular acute


    gout can occur in subsequent episodes.

     The first episode of acute gouty arthritis frequently begins at night


    with dramatic joint pain and swelling.
    Chronic arthritis
     As gout becomes chronic, multiple joints may be involved, and
    deposition of urate crystals in connective tissue (tophi) and kidneys
    may occur.
    Clinical manifestations
     Metatarsophalangeal joint of the first toe is commonly affected
    (podagra), but other joints such as the knee, ankle, PIPs, or DIPs may
    be initially involved

     First episode often occurs at night with severe joint pain waking the
    patient from sleep; the joint rapidly becomes warm, red, and tender
    (it looks exactly like cellulitis)

     Without treatment the joint pain goes away spontaneously within


    3–14 days.
    Precipitating factors
     Excessive alcohol ingestion,
     Red meat intake,
     Trauma,
     Surgery,
     Infection,
     Steroid withdrawal,
     Drugs (hydrochlorothiazide,furosemide, pyrazinamide and ethambutol)
     serious medical illness.
    Differential diagnosis
    • Rheumatoid Arthritis
    • osteoarthritis
    • CPPD
    Diagnosis
    • Even if the clinical appearance strongly suggests gout, the
    presumptive diagnosis ideally should be confirmed by needle
    aspiration of acutely or chronically involved joints.

    • During acute gouty attacks, needle-shaped MSU crystals typically are


    seen both intracellularly and extracellularly
    Radiographic Features
    • Cystic changes, well-defined erosions with sclerotic margins (often
    with overhanging bony edges), and soft tissue masses are
    characteristic radiographic features of advanced chronic gout.

    • Dual-energy computed tomography (CT) can show specific features


    establishing the presence of urate crystals.
    Treatment
    ACUTE GOUTY ARTHRITIS
     The mainstay of treatment during an acute attack is the administration of anti-
    inflammatory drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine,
    or glucocorticoids.

     Both colchicine and NSAIDs may be poorly tolerated and dangerous in the elderly and
    in the presence of renal insufficiency and gastrointestinal disorders.

     Steroids oral (rarely intraarticular) in elderly patients who cannot tolerate NSAIDs/
    colchicine or in patients with renal impairment

     Ice pack applications and rest of the involved joints can be helpful.
     Colchicine : Useful regimens are one 0.6-mg tablet given every 8 h with
    subsequent tapering or 1.2 mg followed by 0.6 mg in 1 h with
    subsequent day dosing depending on response.

     NSAIDs given in full anti-inflammatory doses are effective in ∼90% of


    patients.
    eg. Indomethacin, 25–50 mg tid;
    Naproxen, 500 mg bid;
    Ibuprofen, 800 mg tid;
    Diclofenac, 50 mg tid;
    Celecoxib 800 mg followed by 400 mg 12 h later, then 400 mg bid
    Treatment
    Chronic Arthritis
    • Goal is to decrease uric acid levels. This is usually required for life and
    initiated in those whose recurrent gouty attacks cannot be corrected
    by low-purine diet, alcohol limitation, avoiding diuretics, etc.

    • Unlike acute gout, the uric acid level here may help the physician to
    follow the effect of hypouricemic treatment.
    Treatment
    • Allopurinol can be used in overproducers, undersecretors, or patients
    with renal failure or kidney stones

    • Febuxostat is used in those intolerant of allopurinol.

    • Pegloticase dissolves uric acid: used in refractory disease

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