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1/ About Gout :

-Gout is a condition wherein increased uric acid or urate in the body, also called hyperuricemia, leads to deposition of monosodium urate (MSU) crystals in various tissues

-Affects up to 1-2% of adults & is the most common inflammatory arthritis in men

-Results in acute and chronic inflammation associated w/ changes in articular & periarticular structures

-Hyperuricemia is a necessary precondition for the development of MSU crystal deposition but this has to be distinguished from gout, the clinical syndrome

2/ Causes of:

– Excessive uric acid production:

-Inherited enzyme defects

-Induced by diet, drugs, or toxins (excessive purine in diet, fructose, vitamin B12 deficiency ethanol, , Nicotinic acid, cytotoxic drugs, Warfarin …)

-Clinical disorders (myeloproliferative & lymphoproliferative disorders, malignancies, psoriasis, Down syndrome)

-Decreased renal clearance:

– Induced by diet or drugs (Tacrolimus, Ethambutol, Pyrazinamide, Aspirin, diuretics, Cyclosporine, ethanol, Levodopa)

-Chronic renal insufficiency, volume depletion (volume loss, heart failure ), obesity, diabetic or starvation ketoacidosis, lactic acidosis, hyperparathyroidism, hypothyroidism, sarcoidosis

3/ Classification:

  • Primary hyperuricemia : Uric acid saturation arises w/o coexisting diseases or drugs that alter uric acid production or excretion
  • Secondary hyperuricemia: Excessive uric acid production or diminished renal clearance occurs as a result of a disease, drug, dietary product or toxin

Below is the overview of the disease management of Gout:

knowledge about sick Gout

knowledge about sick Gout

knowledge about sick Gout

knowledge about sick Gout

knowledge about sick Gout

knowledge about sick Gout

 

4/ Clinical Phases of Gout,  Acute Gout:

Usually manifests as an acute, self-limiting, monoarticular inflammatory arthritis in majority of patients

Lower extremity joints are affected more often than upper extremity joints

Joints most commonly affected include the 1st metatarsophalangeal joint (podagra), forefoot, ankle, knee, wrist, elbow & finger joints

Extra-articular sites ( olecranon bursa & Achilles tendon) may also be involved

Attacks may occur & last from a few days to 2-3 wk, w/ resolution of all inflammatory signs

Early attack: <12 hrs after onset of attack

Well-established attack: 12-36 hrs after onset of attack

Late attack: >36 hrs after attack onset

Severity of acute gouty arthritis attack (based on patients’ pain assessment):

Mild: ≤4

Moderate: 5-6

Severe: ≥7

5/ Chronic Gout

+After intermittent attacks (>3 acute attacks/yr) & remissions, the chronic phase follows

+Chronic tophaceous gout:

-Marked by polyarticular arthritis & the formation of tophi which are chalky deposits of monosodium urate

-Tophi are usually painless, appearing as firm, nodular or fusiform masses, located subcutaneously

-Risk factors include polyarticular presentation, serum urate level >0.54 mmol/L (9 mg/dL), age of ≥40 yrs old at disease onset

+Presence of urate nephropathy or urate renal calculi

+Polyarticular flares of gouty arthritis occur, & associated w/ bony erosions & deformities

+Disease severity

-Mild – simple chronic tophaceous gouty arthropathy, 1 joint affected, stable

-Moderate – simple chronic tophaceous gouty arthropathy, 2-4 joints affected, stable

-Severe – chronic tophaceous gouty arthropathy of >4 joints OR ≥1 unstable, complicated, severe articular tophus/tophi

Some drugs treatment of Gout :

-Allopurinol 300mg

-Colchicine 1mg

-Meloxicam 7.5 mg and meloxicam 15 mg

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If you need more information and drug of gout , contact us or comment below

Thank your free times

source : mims

3 Comments

  1. Flossie says:

    You’ve got a great site here! would you like to make some invite posts on my website?

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