Gout 1

(Gout)


(inflammatory arthritis diseases) 5 1000
15

50

(monosodium urate)

(hyperuricemia)

Hyperuricemia

( > 7 mg%. > 6 mg%)

(asymptomatic
hyperuricemia)

30

70

Gout 2



1.

2. 90
35

3.


> 9 mg%

???

purine

uric acid metabolism
(endogenous source)


purine (exogenous source)
purine
12 mg %

Gout 3

(gouty arthritis)

tophi

(gouty nephropathy)
1. (gouty arthritis)
4 (1)
asymptomatic hyperuricemia, (2) acute gouty attack, (3)
intercritical period, (4) chronic tophaceous gout
1.1

Asymptomatic hyperuricemia

:
secondary hyperuricemia



,

myeloproliferative disorder

thiazide

Acute gouty attack
acute monoarthritis abrupness of onset

(1)
(2)
(3) purine

Gout 4
(4) (5)
(
thiazide diuretic, aspirin, anti-TB drug
allopurinol)


1

(acute polyarthritis)

aucte monoarthritis
1. Septic arthritis acute monoarthritis

2. Pseudogout

calcium
pyrophosphate uric acid
3. Traumatic arthritis

Gout 5
1.2

Intercritical period

1.3

Chronic tophacous gout

tophi (

)

hand defomity

rheumatoid nodule
2. (gouty nephropathy)
2

2.1

(uric acid nephropathy)

10-25
40

13 mg%

50

Gout 6




2.2

Interstitial nephropathy (urate nephropathy)

interstitial

1. :

PMN tophi
2.

colchicine
:
1.

2.
NSIADs NSAIDs

pseudogout apatite induced arthritis
NSAIDs

(associated diseases)
1.

Gout 7
2. (hypertriglyceridemia)
3.
4. premature artherosclerosis

1.
2.
3.

4.

5.

6.
1. :
colchicine NSAIDs
1.1

colchicine specific

6-12 1 (0.6
.) 3
1 2
1

Gout 8
1.2

NSAID specific

1-2

1
NSAIDs
NSAID

2.
colchicine 1
2
1-2
3. :

~ 5.5 mg% 2
3.1

(uricosuric

drugs) probenecid benzbromarone

(hyperexcretor)
3.2

(xanthine

oxidase inhibitor) allopurinol

4.

purine

Gout 9
5.

3000

sodium bicarbonate
(pH ~ 7)

(asymptomatic primary
hyperuricemia)
6.

1. , .
. ; 2541; 13:
2. 2548 :