Gout made easy

Friday, May 25, 20127comments

 
gout_medicalshow
Definition: Inflammatory arthritis associated with hyperuricaemia.
There is deposition of sodium urate crystals in:
• Joints: causing arthritis.
• Soft tissues: causing tophi & tenosynovitis.
• Urinary system: causing urate stones & nephropathy.
 
Uric Acid Metabolism

1. Uric acid production:
From breakdown of nucleoproteins & purines.
2. Uric acid excretion:
• Uric acid is completely filtered by the glomeruli.
• It is completely reabsorbed in the proximal tubules.
• 75% is secreted by the distal tubules.



Etiology of Gout
 
I. Primary gout:
• Idiopathic hyperuricaemia due to:
1. Increased uric acid production.
2. Diminished uric acid excretion.
• More common in males in the forties.
• Family history in 20% of cases.
 
II. Secondary gout:
1. Metabolic: Increased uric acid production
A. Enzyme defects:
• Lesch-Nyhan syndrome:
- X-linked recessive disorder.
- Mental retardation.
- Choreo-athetosis.
• G6PD deficiency with glycogen storage disease.
B. Increased cellular destruction:
• Polycythaemia vera.
• Leukemia, especially during treatment.
• Others e.g. carcinoma.
2. Renal: Decreased uric acid excretion.
A. Chronic renal failure.
B. Drugs:
• Loop & thiazide diuretics.
• Low dose aspirin.
C. Increased lactic acid:
• Alcohol.
• Exercise.
• Starvation.
Clinical Picture
I. Gouty arthritis:
1. Acute:
Distribution:
• Monoarticular in 90% of cases.
Uncommonly polyarticular.
• The first metatarsophalangeal joint is the first to be affected.
Less commonly the ankle or the knee.
Precipitation: the attack may be precipitated by
• High protein diet.
• High alcohol consumption.
• Trauma, infections & excess exercise.
• Diuretics, salicylates & cytotoxic drugs.
• Sudden decrease of allopurinol or probenecid.
Discription:
• Severely inflammed joint.
• It is painful, swollen & very tender.
• The overlying skin is red & oedematous.
• Fever may be present.
• Spontaneous recovery occurs within days.
• The attacks are recurrent.
• The joints are free inbetween the attacks.
 
2. Chronic:
• Uncommon except in:
- Elderly people with long use of diuretics.
- Chronic renal failure.
• There is chronic arthralgia with attacks of acute arthritis.
• The affection is polyarticular.
• It may be associated with tophi or nephropathy.
 
II. Gouty tophi:
• In chronic gouty arthritis & marked hyperuricaemia.
Distribution:
- Over the external ear.
- Around the joints.
Discription:
- Smooth yellowish nodules.
- May ulcerate & discharge chalky material.
Cause:
Deposits of urates in the subcutaneous tissues.
 
III. Gouty kidney:
there may be
• Urate stones: may cause hydronephrosis.
• Pyelonephritis: due to decreased resistance.
• Renal hypertension: may cause atherosclerosis.
• Chronic renal failure: may occur.
• Acute renal failure: due to severe hyperuricaemia.
 
IV. Other associations:
1. Obesity.
2. Hyperlipidaemia.
3. Diabetes mellitus, type 2.
4. Ischaemic heart disease.
V. Asymptomatic hyperuricaemia:
This is 10 times more common than gout.
 
Investigations


1. Serum uric acid: more than 7 mg/dl.
2. Synovial fluid: contains urates.
3. X-ray: for kidneys & joints.
4. Biopsy from tophi.
Treatment
I. Treatment of acute attacks:
1. Complete rest:
Of the patient & the affected joint.
2. Local measures:
Local application of ice or lead lotion.
3. NSAIDs:
• Indomethacin (Indocid):
50 mg tds for 2 days, then half the dose for 1week.
• Diclofenac (Voltaren):
The same dose as indomethacin.
4. Colchicine:
1mg/6 hours for 1 week. It is stopped if diarrhoea occurs.
5. Corticosteroids:
IM or intra-articular injections: in severe cases.
 
II. Long term therapy:
A. General measures:
1. Weight reduction.
2. Avoid foods & drinks containing high purines.
3. Avoid excess alcohol.
4. Good fluid intake.
5. Avoid thiazide diuretics & salicylates.
B. Drugs:
1. Allopurinol (Zyloric):
• It is a xanthine oxidase inhibitor.
• It decreases uric acid synthesis.
• It may precipitate acute athritis so:
- It is started 4 weeks after the acute attack.
- Used with colchicine to prevent acute attacks.
• It is indicated in:
- Frequent acute attacks.
- Tophi or chronic gouty arthritis.
- Renal stones.
- Marked hyperuricaemia.
- With treatment of malignancy.
• Dose: 300-900 mg/day.
2. Uricosuric drugs:
• Increase renal excretion of uric acid.
• Probenecid: 1 mg/12 hours.
• They must be given with colchecine.
• They are contraindicated in.
- Renal failure.
- Renal stones.
C. Surgery:
For renal stones & tophi.
Share this article :

+ comments + 7 comments

December 8, 2013 at 6:14 PM

The best simple minimalisttapworld

curtains accept to be the simple chrome ones,Taps

Australia
whether that's for the kitchen as acclimated as a kitchen bore curtains

or acclimated as a ablution curtains in the bath sinks.Kitchen taps With these avant-garde

minimalist curtains the articles consistently analysis the articles afore its alien to

the customers.Shower

heads
You can calmly acquisition superior minimalist curtains for kitchens and bath

throughout the online market.source:http://www.tapworld.com.au/

August 10, 2014 at 5:42 PM

J'ai ensuite place http://www.robinetsale.com/ et utiliser l'outil interactif dans leur onglet de robinetterie cuisine de vie, trouver mon rêve de diriger. robinet LED et ils ont un joli petit 5 problèmes, pour vous aider à choisir le plus adapté à votre Robinetterie Vasque .

October 19, 2014 at 5:06 AM

During installation, it is important that the washbasin LED Taps are mounted. Proper plumbing is important, because the installation is not an easy task and could a mess sometimes. Whenever possible, avoid Do-It-Yourself Plumbing when remodeling a Waterfall Taps, unless you're a plumber, of course r. Plumbing is a complicated job when you do not have a clue how. Thus, it is much better if you let the experts! When shopping for Antique Taps, go to online stores can offer you not only the ease of purchase, but a lot more variety and great Taps Sale .However, make sure the online store where you plan to buy your plumbing fixtures is one of Antique Kitchen Taps.

March 9, 2015 at 8:06 PM

A man of taste quality of life is high, especially bathroom design often can reflect a person's quality of life.Waterfall taps are a stylish way to make a statement in your bathroom, and are becoming increasingly popular and very affordable. http://www.plumpinguk.co.uk/kitchen-taps/wall-mounted-taps.html.It will make your life more refineddand we have created a lot of artistic products of"stylish personality and quality life".

July 20, 2015 at 11:46 PM

Our pneumatic factory was founded in 2000,CHECK HERE. In decades of serving China pneumatic industry, we have built our reputation on product knowledge, world class suppliers, application support, and value add services. Our commitment to our employees, customers and vendors is the core of our business beliefs. In our factory, there are more than 80 front-line workers, 3000 squares working shop.Our main products are air Pneumatic Cylinder, solenoid valve and also a lot of pneumatic fittings like Air Gun.

August 16, 2015 at 7:45 PM

Imagine a beautiful room that draws gasps of appreciation when people enter the room. If you are thinking of your living room, adjust your perspective and take a mental walk to your shower.http://www.findtaps.co.uk/36-shower-taps

October 7, 2016 at 7:35 PM

It is indeed a wonderful http://www.faucetsmarket.com/bathroom-accessory-bathroom-mirrors-c-4_5.html for you to consider as your daily usage. You will love to enjoy the Kitchen faucet from then on. It will bring you an all new feeling. As can see that Antique brass faucet flow decentralizes or sprayed, just spin the button on the head.

Post a Comment

 
Support : Creating Website | Johny Template | Mas Template
Copyright © 2011. Medical Show - All Rights Reserved
Template Created by Creating Website Published by Mas Template
Proudly powered by Premium Blogger Template