diease

Gout


OVERVIEW OF Gout :

It is termed as the deposition of the urate crystals in the joints that interrupts the normal activity of the human being affected with the gout. The term pseudogout is used to describe the deposition of the calcium pyrophosphate crystals at the joints.


CAUSES :

Gout occurs when urate crystals accumulate in your joint, causing the inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood. Your body produces uric acid when it breaks down purines — substances that are found naturally in your body.

Purines are also found in certain foods, including red meat and organ meats, such as liver. Purine-rich seafood includes anchovies, sardines, mussels, scallops, trout and tuna. Alcoholic beverages, especially beer, and drinks sweetened with fruit sugar (fructose) promote higher levels of uric acid.

Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes either your body produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needlelike urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.

Complication:

  • Recurrent gout. Some people may never experience gout signs and symptoms again. Others may experience gout several times each year. Medications may help prevent gout attacks in people with recurrent gout. If left untreated, gout can cause erosion and destruction of a joint.
  • Advanced gout. Untreated gout may cause deposits of urate crystals to form under the skin in nodules called tophi (TOE-fie). Tophi can develop in several areas, such as your fingers, hands, feet, elbows or Achilles tendons along the backs of your ankles. Tophi usually aren't painful, but they can become swollen and tender during gout attacks.
  • Kidney stones. Urate crystals may collect in the urinary tracts of people with gout, causing kidney stones. Medications can help reduce the risk of kidney stones.

 


PATHOPHYSIOLOGY :

Crystals include monosodium urate as in gout,disodium phosphoglycerate as in pseudo gout,calcium phosphate .these are termed as exogenous crstals.Endogenous crystals include corticosteroid crystals,polyethylene,methylacrylate and talcum.deposition of these crystals occurs in spaces between the articular joint.

  • Gout and gouty arthritis
  • Calcium pyrophosphate crystal deposition disease (pseudo-gout)


COMMON CLINICAL SIGNS AND SYMPTOMS :

Pain during movement of the joints

Malaise and fatigue

Weight loss

Rashes

Muscle ache and pain

Tenderness

Numbness and tingling

Reduced range of motions


DIAGNOSTIC :

The normal uric acid level is checked. In women – 2.4 to 6 and in males 3.4 to 7.

Laboratory test:

Analysis of different types of body fluid is indicated.Fluids include blood,urine and joint fluids.

Synovial fluid:

It is the identification of the monosodium urate crystals in the synovial fluid or tophus. The fluid is removed by the process known as arthrocntesis. In polaried light it shows needle like biferinges.

Imaging:

Xrays-bone can show damage to cartilage,bone damage and bone spurs.but xray fails to show any arthritic damage

Computerized tomography:it shows cross sectional views of internal structures.

Magnetic resonance imaging:

Cross section studies of soft tissues such as cartilage ,tendons and ligaments are obtained.

Ultrasound:

Soft tissue image,cartilage and fluid structure are obtained.

Arthroscopy:

It is an 3D device used to visualize the joint images.

Dual-energy computerized tomography (DECT). This test combines X-ray images taken from many different angles to visualize urate crystals in joints


TREATMENT AND PROGNOSIS :

      Treatment options varies from indivduals.The main treatments include physiotherapy.diet control,joint replacement therapy,and certain medications to get relieve from symptoms.

Medications used:

  • Medications that block uric acid productio:
  • Drugs such as allopurinol (Aloprim, Lopurin, Zyloprim) and febuxostat (Uloric) help limit the amount of uric acid your body makes. Side effects of allopurinol include fever, rash, hepatitis and kidney problems. Febuxostat side effects include rash, nausea and reduced liver function. Febuxostat also may increase the risk of heart-related death.
  • Medications that improve uric acid removal. Drugs such as probenecid help improve your kidneys' ability to remove uric acid from your body. Side effects include a rash, stomach pain and kidney stones.
  • Colchicine:

It is medicine of alternative for those unable to tolerate NSAIDs.  Colchicine may interact with other commonly prescribed drug such as  atorvastatin and erythromycin.

  • Glucocorticoids:

It is found to be as affective NSAIDs. They provide relief when they are injected into the joints.

 

  • Others:

Interleukin 1 inhibitor canakinumab showed moderate effectiveness for pain relief and reduction of joint swelling.

 

Physical therapy:

Physical exercises provides greater releif from pain in arthritis and it also increases the flexibility of the joints to certain degrees.

Patients suffering from arthritis can benefit from both physical as well as occupational therapy. In arthritis the joints become stiff and the range of movement are limited to the extent.. Physical therapy has been shown to significantly improve function, decrease pain, and delay need for surgical intervention in advanced cases. Exercise prescribed by a physical therapist has been shown to be more effective than medications in treating osteoarthritis of the knee. Exercises mostly focuses on the flexibility and strength of the joints.  Occupational therapy can provide assistance with activities.

Medications

They are various treatment options available for the treatment of arthritis and medications which has lower side effects are selected as the first choice of treatment in arthritis.

Peglitose and Lecinurad is given to reduce the uric acid level.

Depending on the type of arthritis, the medications that are given may be different. For example, the first-line treatment for arthritis is acetaminophen(paracetamol) while for inflammatory and non inflammmatory arthritis such as ibuprofen. Opioids and NSAIDs may be less well tolerated. However, topical NSAIDs may have better safety profiles than oral NSAIDs. For more severe cases of osteoarthritis, intra-articular corticosteroid injections may also be considered.

Surgery:

Orthroscopic surgery for arthritis does not provide much effect.

Adaptive aids:

People with hand arthritis can have trouble with simple activities daily doing  tasks (ADLs), such as turning a key in a lock or opening jars, as these activities can be cumbersome and painful. Adaptive aids or assistanve aids are available in the market  to assist the patient and simplyfing those task to them. but they are generally more costly than conventional products with the same function. It is now possible to 3D print adaptive aids, which have been released as open source hardware to reduce patient costs. Adaptive aids can significantly help arthritis patients and the vast majority of those with arthritis need and use them.


PROGNOSIS :

The gout gets subsided within 5-7 days.

 


PREVENTION :

Take proper diet that does not causes increase in uric acid level

Do stretch exercises

Reduce the body weight

Eat fish or twice a week-since fish contains omega 3 fatty acids which can reduce inflammation in the bone.

Exercise regularly

Protect the joints and avoid joint injuries

 


Medicines used in the Treatment :

Allopurinol

Probneacid

peglitose

Colichine

Canakinumab


REFERENCE :

https://en.wikipedia.org/wiki/Gout

https://www.medicalnewstoday.com/articles/144827

https://emedicine.medscape.com/article/329958-overview