HOW GOUT (TOPHI) OCCURS?

Gout is a medical condition usually characterized by recurrent attacks of acute inflammatory arthritis which results red, tender and swollen joint. When gout occurs at big toe it is called as Podagra. The most commonly affected area is Metatarsal-phalangeal joint the base of bog toe. Gout sometimes presents with tophi ( uric acid crystals builds up around the joint), Kidney stones. 

WHAT ARE THE CAUSES OF GOUT?

Hyperuricemia is the root cause of gout. Hyperuricemia is elevation of uric acid level in the blood which leads to formation of crystals. These crystals are deposited in the joints, tendons and surrounding tissues. Hyperuricemia can occur for number of reasons in that renal under excretion of uric acid ( 90%) is primary cause and over production of uric acid another cause. About 10% of people experience gout at some point of lifetimes. 

Some dietary causes of gout include consumption of alcohol, Fructose sweetened drinks, meat and sea food. Other triggers include physical trauma and surgery. some genetic disorders may cause gout familial juvenile hyperuricemic nephropathy, medullary cystic kidney disease and hypoxanthine-guanine phosphoribosyltransferase deficiency as seen in Lesch-Nyhan syndrome.

gout frequently occurs in combination with some medical conditions like abdominal obesity, hypertension, metabolic syndrome, Insulin resistance and abnormal lipid levels. Some medications like Cyclosporine, hydrochlorthiazide and diuretics associated with attacks of gout.

WHAT ARE THE SIGN AND SYMPTOMS OF GOUT?

Redness of the skin at infected joints

Hyperuricemia

Stone formation due to high uric acid level

Tophi – Extensive tophi may leads to chronic arthritis

Fatigue and high fever

DIAGNOSIS OF GOUT

Gout may be diagnosed by X- ray and Synovial fluid analysis should be done.

Blood test – If the person blood contain higher amount of uric acid that indicates the Gout 

If the person suffering with hyperuricemia and the podagra indicates the Gout without further investigation.

PATHOPHYSIOLOGY OF GOUT

Purine Metabolism is the main cause of Gout Because final metabolite of Purine metabolism uric acid crystallizes in the form of monosodium  urate precipitating in joints, tendons and surrounding tissues. These crystals trigger a local immune-mediated inflammatory reaction with one of the key protein  in the inflammation is interleukin 1β.

HYPOXANTHINE  ——————–  XANTHINE  ——————-  URIC ACID

PREVENTION OF GOUT

By Medication, Dietary and lifestyle can changes ( decrease ) the uric acid levels in the body. Reduce the intake of uric acid elevated foods like sea food, meat, vitamin C and alcohol. Obesity also one of the cause so avoid intake of junk food, eat low calorie food and regular exercise can help to protect from Gout. Sleep Apnea also one of reason for gout. Treatment of apnea leads to decrease the risk of gout.

TREATMENT OF GOUT

NSAIDs (Non steriodal anti inflammatory drugs), Colchicine, Pegloticase are generally  used for Acute conditions.

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