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Gout

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Sriloy Mohanty
Sriloy Mohanty

The document discusses gout, a type of arthritis caused by uric acid crystals in the joints. It defines gout, lists its symptoms such as sudden severe pain in joints like the big toe, and describes its typical progression from asymptomatic to acute attacks to a chronic condition if left untreated. Risk factors include being male, obesity, diet high in purines, and certain medications. Diagnosis involves examining synovial fluid for uric acid crystals. Treatment focuses on relieving acute attacks, preventing future attacks by reducing uric acid levels in the blood long-term through medications and diet changes, and managing chronic complications through continued medical care.

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GOUT The Disease Of Kings Presented By Sriloy Mohanty B.N.Y.S S-VYASA University
Contents… Introduction Definition Epidemiology Symptoms Causes Risk factors Diagnostic procedure Treatment protocol Treatment by natural modalities Research articles 2 sriloy21@gmail.com
Introduction Gout comes from Latin gutta and old French gote meaning "a drop." Several hundred years ago gout was thought to be caused by drops of viscous humors that seeped from blood into the joints Gouty arthritis in one or more joints (but less than four) May be precipitated by trauma, surgery, alcohol ingestion, or infection 3 sriloy21@gmail.com
Definition It can be defined as the pathological reaction of the joint or periarticular tissues to the presence of monosodium urate monohydrate crystals 4 sriloy21@gmail.com
Epidemiology • About 10% of people with hyperuricemia develop gout at some point in their lifetimes • Depending on the degree of hyperuricemia ▫ When levels are between 415 and 530 μmol/l (7 and 8.9 mg/dl), the risk is 0.5% per year ▫ while in those with a level greater than 535 μmol/l (9 mg/dL), the risk is 4.5% per year. 5 sriloy21@gmail.com
The Four Stages of Gout • Asymptomatic • Acute • Intercritical • Chronic 6 sriloy21@gmail.com
ASYMPTOMATIC • A- meaning without indicates that there are no symptoms associated • Patient will be unaware of what is happening • Gout can only be determined with the help of a physician 7 sriloy21@gmail.com
ACUTE • Sever and sudden onset • Involve one or a few joints • Frequently starts nocturnally • Joint is warm, red, and tender 8 sriloy21@gmail.com
INTERCRITICAL • More concentration of uric acid crystals • Typically no need for drug intervention at the time. 9 sriloy21@gmail.com
CHRONIC • Continuous or persistent over a long period of time • Treatment required • Not easily or quickly resolved 10 sriloy21@gmail.com
Clinical Manifestations Onset usually nocturnal, with sudden swelling and excruciating pain Joint pain usually begins over 2–4 hours and during the night May have low grade fever Usually subsides within 2-10 days Joints are normal, with no symptoms between attacks 11 sriloy21@gmail.com
Other Symptoms • the heels, knees, wrists, and fingers, may also be affected • The reason for onset at night is due to the lower body temperature • Other symptoms may rarely occur along with the joint pain, including fatigue and a high fever 12 sriloy21@gmail.com
Causes • Diet • Genetic predisposition (SLC2A9, SLC22A12, and ABCG2) • Under excretion of urate (90%) • The salts of uric acid • Insulin resistance • Regular aspirin and niacin use THE MAIN CAUSE IS THE IMBALANCE BETWEEN THE INTAKE AND EXCREATION. 13 sriloy21@gmail.com
Risk factors • Males after the age of 20 • Female after menopause • High BMI • Diet rich in seafood • HTN • Thiazide diuretics • Excess alcohol use 14 sriloy21@gmail.com
Pathophysiology Uric acid is end product of purine metabolism and is excreted by the kidneys Hyperuricemia Diet high in purines will not cause gout, but may trigger an attack in a susceptible person 15 sriloy21@gmail.com
16 sriloy21@gmail.com
Complications Joint deformity Osteoarthritis Tophi may produce draining sinuses that may become infected Renal stones, pyelonephritis, obstructive renal disease 17 sriloy21@gmail.com
Tophi-(Solid urate deposits in tissues) Gross appearance of tophi X-ray view of a tophi 18 sriloy21@gmail.com
Diagnosis History & physical examination Clinical symptoms alone are sufficient to make accurate DX in most cases Family history of gout Diagnostic studies 19 sriloy21@gmail.com
Diagnostic Studies Serum uric acid levels 420 μmol/l (7.0 mg/dl) in males and 360 μmol/l (6.0 mg/dl) in females WBC elevated during acute attack ESR 24 hour urine uric acid levels Synovial fluid aspiration contains uric acid crystals  Seldom necessary X-rays appear normal in early stages; tophi appear as eroded areas of bone 20 sriloy21@gmail.com
SYNOVIAL FLUID ANALYSIS (Polarized Light Microscopy) The Gold standard Crystals intracellular during attacks Needle & rod shapes 21 sriloy21@gmail.com
Treatment protocol Acute attack Colchicines produces dramatic anti-inflammatory effects with relief within 24-48 hours NSAIDs for additional pain relief Corticosteroids (intra-articular) Adrenocorticotropic hormone (ACTH) Joint aspiration to decompress 22 sriloy21@gmail.com
Prevention of acute attacks Colchicine combined with: Allopurinol (zyloprim, alloprim) – blocks production of uric acid Probenecid (benemid), sulfinpyrazone (anturane) – inhibit tubular reabsorption of uric acid Febuxostat (uloric) – inhibits xanthine oxidase, recently shown to reduce serum uric acid levels 23 sriloy21@gmail.com
Dietary measures Weight reduction Avoidance of alcohol more low-fat dairy products Avoidance of foods high in purines 24 sriloy21@gmail.com High: mussels, liver, kidney, meat soups, sweetbreads, beer & wine Moderate: Chicken, salmon, crab, mutton, pork, beef, ham Vitamin C intake of 1,500 mg per day decreases the risk of gout by 45% Coffee, but not tea, consumption is associated with a lower risk of gout
What we can eat without fear  Bread (white) and crackers  Butter or margarine (in moderation)  Cake and cookies  Carbonated beverages  Cereals  Cheese  Chocolate  Coffee  Cream (in moderation)  Custard  Eggs  Fats (in moderation)  Fruit  Gelatin desserts  Herbs • Ice cream • Milk • Noodles • Nuts • Oil • Olives • Pickles • Pasta • Popcorn • Puddings • Relishes • Rice • Salt • Sugar and sweets • Tea • Vegetables (except those mentioned in the first group) • Vinegar 25 sriloy21@gmail.com
Home remedy Raise and rest your limb Use a splint to immobilize the joint Do not do vigorous exercise apply an ice pack or bag of frozen vegetables wrapped in a towel Do not cover the joint. 26 sriloy21@gmail.com
Acupuncture • Sedative points- gv-20, • Homeostasis point-Li-11 • Analgesic point- st-44 • Immune mechanism- Du-14, Sp-6, St-36 • Influential point-UB-17, UB-11 • Point for Pruritis-Sp-10,UB-16 • Some local points 27 sriloy21@gmail.com
Thank You
29 sriloy21@gmail.com

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Gout

  • 1. GOUT The Disease Of Kings Presented By Sriloy Mohanty B.N.Y.S S-VYASA University
  • 2. Contents… Introduction Definition Epidemiology Symptoms Causes Risk factors Diagnostic procedure Treatment protocol Treatment by natural modalities Research articles 2 [email protected]
  • 3. Introduction Gout comes from Latin gutta and old French gote meaning "a drop." Several hundred years ago gout was thought to be caused by drops of viscous humors that seeped from blood into the joints Gouty arthritis in one or more joints (but less than four) May be precipitated by trauma, surgery, alcohol ingestion, or infection 3 [email protected]
  • 4. Definition It can be defined as the pathological reaction of the joint or periarticular tissues to the presence of monosodium urate monohydrate crystals 4 [email protected]
  • 5. Epidemiology • About 10% of people with hyperuricemia develop gout at some point in their lifetimes • Depending on the degree of hyperuricemia ▫ When levels are between 415 and 530 μmol/l (7 and 8.9 mg/dl), the risk is 0.5% per year ▫ while in those with a level greater than 535 μmol/l (9 mg/dL), the risk is 4.5% per year. 5 [email protected]
  • 6. The Four Stages of Gout • Asymptomatic • Acute • Intercritical • Chronic 6 [email protected]
  • 7. ASYMPTOMATIC • A- meaning without indicates that there are no symptoms associated • Patient will be unaware of what is happening • Gout can only be determined with the help of a physician 7 [email protected]
  • 8. ACUTE • Sever and sudden onset • Involve one or a few joints • Frequently starts nocturnally • Joint is warm, red, and tender 8 [email protected]
  • 9. INTERCRITICAL • More concentration of uric acid crystals • Typically no need for drug intervention at the time. 9 [email protected]
  • 10. CHRONIC • Continuous or persistent over a long period of time • Treatment required • Not easily or quickly resolved 10 [email protected]
  • 11. Clinical Manifestations Onset usually nocturnal, with sudden swelling and excruciating pain Joint pain usually begins over 2–4 hours and during the night May have low grade fever Usually subsides within 2-10 days Joints are normal, with no symptoms between attacks 11 [email protected]
  • 12. Other Symptoms • the heels, knees, wrists, and fingers, may also be affected • The reason for onset at night is due to the lower body temperature • Other symptoms may rarely occur along with the joint pain, including fatigue and a high fever 12 [email protected]
  • 13. Causes • Diet • Genetic predisposition (SLC2A9, SLC22A12, and ABCG2) • Under excretion of urate (90%) • The salts of uric acid • Insulin resistance • Regular aspirin and niacin use THE MAIN CAUSE IS THE IMBALANCE BETWEEN THE INTAKE AND EXCREATION. 13 [email protected]
  • 14. Risk factors • Males after the age of 20 • Female after menopause • High BMI • Diet rich in seafood • HTN • Thiazide diuretics • Excess alcohol use 14 [email protected]
  • 15. Pathophysiology Uric acid is end product of purine metabolism and is excreted by the kidneys Hyperuricemia Diet high in purines will not cause gout, but may trigger an attack in a susceptible person 15 [email protected]
  • 17. Complications Joint deformity Osteoarthritis Tophi may produce draining sinuses that may become infected Renal stones, pyelonephritis, obstructive renal disease 17 [email protected]
  • 18. Tophi-(Solid urate deposits in tissues) Gross appearance of tophi X-ray view of a tophi 18 [email protected]
  • 19. Diagnosis History & physical examination Clinical symptoms alone are sufficient to make accurate DX in most cases Family history of gout Diagnostic studies 19 [email protected]
  • 20. Diagnostic Studies Serum uric acid levels 420 μmol/l (7.0 mg/dl) in males and 360 μmol/l (6.0 mg/dl) in females WBC elevated during acute attack ESR 24 hour urine uric acid levels Synovial fluid aspiration contains uric acid crystals  Seldom necessary X-rays appear normal in early stages; tophi appear as eroded areas of bone 20 [email protected]
  • 21. SYNOVIAL FLUID ANALYSIS (Polarized Light Microscopy) The Gold standard Crystals intracellular during attacks Needle & rod shapes 21 [email protected]
  • 22. Treatment protocol Acute attack Colchicines produces dramatic anti-inflammatory effects with relief within 24-48 hours NSAIDs for additional pain relief Corticosteroids (intra-articular) Adrenocorticotropic hormone (ACTH) Joint aspiration to decompress 22 [email protected]
  • 23. Prevention of acute attacks Colchicine combined with: Allopurinol (zyloprim, alloprim) – blocks production of uric acid Probenecid (benemid), sulfinpyrazone (anturane) – inhibit tubular reabsorption of uric acid Febuxostat (uloric) – inhibits xanthine oxidase, recently shown to reduce serum uric acid levels 23 [email protected]
  • 24. Dietary measures Weight reduction Avoidance of alcohol more low-fat dairy products Avoidance of foods high in purines 24 [email protected] High: mussels, liver, kidney, meat soups, sweetbreads, beer & wine Moderate: Chicken, salmon, crab, mutton, pork, beef, ham Vitamin C intake of 1,500 mg per day decreases the risk of gout by 45% Coffee, but not tea, consumption is associated with a lower risk of gout
  • 25. What we can eat without fear  Bread (white) and crackers  Butter or margarine (in moderation)  Cake and cookies  Carbonated beverages  Cereals  Cheese  Chocolate  Coffee  Cream (in moderation)  Custard  Eggs  Fats (in moderation)  Fruit  Gelatin desserts  Herbs • Ice cream • Milk • Noodles • Nuts • Oil • Olives • Pickles • Pasta • Popcorn • Puddings • Relishes • Rice • Salt • Sugar and sweets • Tea • Vegetables (except those mentioned in the first group) • Vinegar 25 [email protected]
  • 26. Home remedy Raise and rest your limb Use a splint to immobilize the joint Do not do vigorous exercise apply an ice pack or bag of frozen vegetables wrapped in a towel Do not cover the joint. 26 [email protected]
  • 27. Acupuncture • Sedative points- gv-20, • Homeostasis point-Li-11 • Analgesic point- st-44 • Immune mechanism- Du-14, Sp-6, St-36 • Influential point-UB-17, UB-11 • Point for Pruritis-Sp-10,UB-16 • Some local points 27 [email protected]