Gout

A disorder of purine metabolism and form of arthritis.

Uric acid  crystallizes in the form of monosodium urate, precipitating in joints, on tendons, and in the surrounding tissues. Uric acid is the purine metabolism end product.

Pathophysiology:

Uric acid crystallization and precipitation triggers are not well understood. Factors believed to be important in triggering an acute episode of arthritis include cool temperatures and rapid changes in uric acid levels.

Etiology:

  • Diet: increased protein intake, alcohol consumption or high dietary fructose intake
  • Sudden weight loss
  • chemotherapy
  • Genetic predisposition
  • Hypouremic acid secretion by the kidneys

Medical conditions such as:

  • metabolic syndrome
  • abdominal obesity
  • Hypertension
  • insulin resistance
  • lipid dyscrasias

Medications correlated with gout include:

  • cyclosporins
  • immunosuppressants
  • diuretics

 

Manifestations:

  • presents with recurrent attacks of acute inflammatory arthritis, particularly of the big toe
  • Hyperuricemia

Treatment and Management:

  1. Medications – non-steroidal anti-inflammatories, colchicine and glucocorticoids
  2. Dietary Changes (lower protein intake and increase dairy product consumption)
  3. Maintain physical fitness level
  4. Treatment and management of insulin resistance


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