Gout & hyperuricemia Dr.zaid shahwanii
Gout is condition that results from crystals of uric acid depositing in tissues of the body. It is characterized by an overload of uric acid (which is a breakdown product of purines), in the body causing a recurrent attacks of joint inflammation (arthritis) + deposits of hard lumps & crystals of uric acid in and around the joints & in the kidney leading to decreased kidney function, and stones formation The term "gout" commonly is used to refer to the painful arthritis attacksIn addition to an inherited abnormality in handling uric acid there are multiple risk factors :-
Obesity, excessive weight gain,, especially in youth, moderate to heavy alcohol intake, High blood pressure, and abnormal kidney function. Certain drugs, such as thiazide diuretics, low-dose aspirin,cyclosporine, tuberculosis medications (pyrazinamide and ethambutol), Certain diseases lead to excessive production of uric acid in the body. Examples of these diseases include leukemias, lymphomas, and hemoglobin disorders. Certain conditions can precipitate acute attacks of gout. These conditions include dehydration, injury to the joint, fever, and recent surgery.
Histopathology Gout is nine times more common in men than in women. It predominantly attacks males after puberty, with a peak age of 75. In women, gout attacks usually occur after menopause.
Gouty arthritis is usually an extremely painful attack with a rapid onset of joint inflammation. The joint inflammation is precipitated by deposits of uric acid crystals in the joint fluid (synovial fluid) and joint lining (synovial lining). Intense joint inflammation occurs as white blood cells engulf the uric acid crystals and release chemicals of inflammation, causing pain, heat, and redness of the joint tissues.
Signs & symptoms
The small joint at the base of the big toe is the most common site of an acute gout attack. Other joints that can be affected include the ankles, knees, wrists, fingers, & elbows. The symptoms are rapid onset of pain in the affected joint ,,followed by warmth, swelling, reddish discoloration & marked tenderness. These painful attacks usually subside in hours to days, with or without medication.(.
Uric acid crystals can deposit in tiny fluid-filled sacs (bursae) around the joints. These urate crystals can incite inflammation in the bursae leading to pain and swelling around the joints, a condition called bursitis. In rare instances, gout leads to a more chronic type of joint inflammation which mimics rheumatoid arthritis
3) X-rays may show tophi crystal deposits and bone damage as a result of repeated inflammations of the joints .
Diagnosis & Treatment
1) clinical features 2) finding uric acid crystals in the joint fluid obtained by joint aspiration (arthrocentesis). performed under local anesthesia Using sterile technique,(( the fluid will contain Shiny, needle-like uric acid crystals under a polarizing microscope .)).Prevention of acute gout involves
maintaining adequate fluid intake (decreases the risk of kidney stone formation), weight reduction (by reducing dietary fat and calorie intake, combined with a regular aerobic exercise program)). dietary changes (purine rich foods are avoided eg. organ meats, such as liver, brains, kidneys, and sweetbreads ), reduction in alcohol consumption( beer and liquor were particularly strong factors). medications to reduce hyperuricemia,,either by increasing the kidney excretion of uric acid, or by decreasing the body's production of uric acid from the purine in foods In acute gout attack( nonsteroidal antiinflammatory drugs (NSAIDS) such as indomethacin .naproxain , colchicine (cause severe diarrhea,nausea and vomiting ) and corticosteroids (prednisone ),,long term tretment (allopurinol) affect purine metabolisum to uric acide.pseudogout
Pseudogout is a type of inflammation of joints (arthritis) that is caused by deposits of crystals, called calcium pyrophosphate, in and around the joints. Pseudogout literally means "false gout." the crystal that incites the inflammation of gout is monosodium urate each have distinct appearances when joint fluid containing them is viewed under a microscope. This makes it possible to precisely identify the cause of the joint inflammation when joint fluid is available. symptoms of pseudogout Pseudogout can result in arthritis of a number of joints but commonly involves the knees, wrists, shoulders, hips, and/or ankles. Pseudogout usually affects only one or a few joints at a time. The "attacks" of joint inflammation, characterized by acute joint swelling, warmth, stiffness, and pain, may last for days to weeks and can resolve spontaneously.Diagnosis & Treatment
Diagnosis Pseudogout is suggested when abnormal calcifications are seen in the cartilage of joints on x-ray .These calcifications are referred to as chondrocalcinosis. The arthritis of pseudogout is common in older adults, particularly in the context of dehydration such as occurs with hospitalization or surgery. The diagnosis of pseudogout is ultimately made when fluid from a joint is examined under a special microscope called a polarizing microscope. With this microscope, the calcium pyrophosphate crystals are identified. Treatments for pseudogout The treatment of pseudogout is directed toward stopping the inflammation in the joints. Local ice applications and resting can help. Nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen and others are often first drugs of choice. Removing fluid containing the crystals from the joint can reduce pain and help the inflammation to diminish more quickly. Cortisone injected into an inflamed joint and oral colchicine are also used. Long-term prevention of recurrent pseudogout is often best achieved with small daily doses of colchicine