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Gouty Arthritis

Gouty Arthritis

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Published by: likeblack001 on Jun 02, 2011
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Gouty arthritis

Intense joint inflammation occurs as the immune system reacts. The joint inflammation is precipitated by deposits of uric acid crystals in the joint fluid (synovial fluid) and joint lining (synovial lining). it causes recurring attacks of joint inflammation (arthritis). Historically it has been referred to as "the disease of kings"or "rich man's disease". also commented on it. and redness of the joint tissues. later onset in women. Uric acid is a breakdown product of purines that are part of many foods we eat. The Greek physician Hippocrates around 400 BC. and kidney stones. and blockage of the kidney-filtering tubules with uric acid crystals. Gouty arthritis is typically an extremely painful attack with a rapid onset of joint inflammation. kidney stones. around 1200 AD. Gout is considered a chronic and progressive disease. It is derived from the Latin word gutta. The term gout refers the disease that is caused by an overload of uric acid in the body. the attacks of gouty arthritis typically occur more frequently and often in additional joints ALTERNATIVE NAMES Metabolic arthritis Tophi Acute hyperurecemia Disease of kings Rich man¶s disease History Anton van Leeuwenhoek described the microscopic appearance of uric acid crystals in 1679. The first documented description is from Egypt in 2. Chronic gout can also lead to deposits of hard lumps of uric acid in the tissues. An abnormality in handling uric acid can cause attacks of painful arthritis (gout attack). especially the joints.DEFINITION Gout is a disease that results from an overload of uric acid in the body. This overload of uric acid leads to the formation of tiny crystals of urate that deposit in tissues of the body. resulting in painful arthritic attacks and deposits of lumps of uric acid crystals in body tissues. decreased kidney function. leading to kidney failure. heat. The word gout was initially used by Randolphus of Bocking. Gout has the unique distinction of being one of the most frequently recorded medical illnesses throughout history. particularly in and around the joints and may cause joint destruction. Gout has however been known since antiquity. When crystals form in the joints. meaning "a drop" (of liquid). Aulus Cornelius Celsus (30 AD) described the linkage with alcohol. leading to pain.600 BC. It is often related to an inherited abnormality in the body's ability to process uric acid. As gout progresses. and associated kidney problems: . causing white blood cells to engulf the uric acid crystals and chemical messengers of inflammation to be released.

forming sharp. These seldom attack eunuchs or boys before coition with a woman. uric acid can build up. or women except those in whom the menses have become suppressed. mead and venery. herring. In 1848 English physician Alfred Baring Garrod realized that this excess uric acid in the blood was the cause of gout. Normally. indicates that pain and disease are to be apprehended in the region of joints or viscera. who rarely develop the disorder before menopause.Again thick urine.. anchovies. It occurs more commonly in males than in females. the sediment from which is white. inflammation and swelling. SIGNS AND SYMPTOMS . The Dutch scientist Antonie van Leeuwenhoek first described the microscopic appearance of urate crystals in 1679. needle-like urate crystals in a joint or surrounding tissue that cause pain. such as occur in cases of podagra and cheiragra. uric acid dissolves in your blood and passes through your kidneys into your urine. causing the inflammation and intense pain of a gout attack. When this happens.. Urate crystals can form when you have high levels of uric acid in your blood. some have obtained lifelong security by refraining from wine. Joint troubles in the hands and feet are very frequent and persistent.. But sometimes your body either produces too much uric acid or your kidneys excrete too little uric acid.. -People who have had an organ transplant are more susceptible to gout CAUSES Gout occurs when urate crystals accumulate around your joint. Your body produces uric acid when it breaks down purines ² substances that are found naturally in your body ² as well as in certain foods. asparagus and mushrooms.4 of every 1000 people -Rare in children and young adults -Men.3% and it appears to be on the rise. particularly those between the ages of 40-50 years old are more likely to develop gout than women. INCIDENCE The prevalence of gout is reported to be less than 1% to 15. The incidence increases with age and body mass index. -Increase with age body mass index -Occurs in 8. such as organ meats.

swollen joint). This may result in urate nephropathy . non-painful deposits of uric acid crystal known as tophi.>Gout can present in a number of ways. >Other joints such as the heels. >Long-standing elevated uric acid levels (hyperuricemia) may result in other symptomatology including hard. Extensive tophi may lead to chronic arthritis due to bone erosion >Elevated levels of uric acid may also lead to crystals precipitating in the kidneys resulting in stone formation. >Other symptoms that may occur along with the joint pain include fatigue and a high fever. hot. wrists and fingers may also be affected. Joint pain usually begins over 2±4 hours and during the night. accounting for half of cases. although the most usual is a recurrent attack of acute inflammatory arthritis (a red. tender. knees. >The metatarsal-phalangeal joint at the base of the big toe is affected most often. The reason for onset at night is due to the lower body temperature during this time.

the person has elevated levels of uric acid in the blood but no other symptoms. Interval gout. Diagnostic examination -Physical examination -Polarized light microscopy of the synovial fluid of the involved joint >identify and characterize crystals . Asymptomatic hyperuricemia. Gout occurs more often in men than it does in women. leukemia. and hemoglobin disorders. Acute gout or arthritis.  untreated high blood pressure (hypertension) and chronic conditions such as diabetes. 3. commonly occurs in night. however. women's uric acid levels approach those of men. lymphomas. you're more likely to develop the disease. Men also are more likely to develop gout earlier ² usually between the ages of 40 and 50 ² whereas women generally develop signs and symptoms after menopause. primarily because women tend to have lower uric acid levels than men do. person has normal joint function and does not have any symptoms 4. The use of thiazide diuretics ² commonly used to treat hypertension ² and low-dose aspirin also can increase uric acid levels. Age and sex. it does not usually requires treatment 2.STAGES 1. Certain diseases and conditions make it more likely that you'll develop gout.hyperurecemia has caused the deposits of uric acid crystals in joint spaces and leads to a sudden onset of intense pain and swelling of joints. Choices you make in your everyday life may increase your risk of gout. Excessive alcohol use ² generally more than two drinks a day for men and more than one for women ² increases the risk of gout. Family history of gout/genetics.  Moderate to heavy drinker Medical conditions. Chronic tophaceous gout.period between acute attacks. Certain medications. narrowing of the arteries (arteriosclerosis) obesity. high levels of fat and cholesterol in the blood (hyperlipidemia). After menopause. If other members of your family have had gout.most disabling stage and usually develops over a long period as 10 years RISK FACTORS y y y y y Lifestyle factors.

-Arthrocentesis >most reliable test for gout is finding uric acid crystals in a sample of the joint fluid obtained by joint aspiration . Use of CT may assist in differentiating tophi from other subcutaneous nodules. and thickening of the synovium. overhanging margin bone. Chronic tophaceous gout often presents as juxtarticular soft-tissue masses. sharply defined erosions. -CT scans >excellent visualization of tophi.-xray >show tophi-crystal deposits and bone damage as a result of repeated bouts of inflammation -MRI >use for visualization.

-Blood test >to measure the uric acid level in your blood .

Midfoot (metatarsal bones) and hindfoot (tarsal bones) make up your foot arches. It is essential for walking. which require a lot of stability and flexibility. . ligaments. muscles and tendons of your foot. running and jumping. and your flexor. Your lower leg muscles muscles and tendons attach on the top of your foot. heel and ankle. instep. Your achilles tendon is the strongest and largest tendon in your body and it connects your calf muscles (gastrocnemius and soleus) to your heel bone (calcaneus). 3. abduction (moving foot outward) and 4. Your foot bones work with your foot muscles to move your foot in 4 directions: 1. abductor and adductor muscles and tendons attach on the bottom of your foot. dorsiflexion (moving foot upward) 2. these are responsible for weight bearing and propulsion. Forefoot is comprised of 4 smaller toes (phalanges) and 1 big toe (hallux) 2. plantar flexion (moving foot downward towards sole). adduction (moving foot inward).Anatomy and Physiology Your foot is made up of 3 sections: 1. allowing your foot to push off when your calf muscles tighten. y Arches contain bones.

Pathophysiology Predisposing factors age gender family history medical conditions Precipitating factors diet lifestyle medications alcohol consumption Purines are metabolized into Uric acid Hyperuricemia Monosodium urate crystals deposited in tendons. thus inflammation Signs and symptoms of gouty arthritis GOUTY ARTHRITIS If treated: Termination of acute attacks of gout Normal uric acid level If untreated: Chronic topaceous gout Kidney stones Chronic renal disease . kidneys and other organs Triggers a local immune mediated inflammatory response. joint.

Management a. dissolve deposited urate  Allopurinol ± DOC for kidney stones  Corticosteroids ± incase of drug resistance  Low purine diet  Lifestyle changes b. Nursing management  Low purine diet  Limit/stop alcohol intake  Pain management  ROM exercises  Proper health education  Immobilize affected part and elevate  Rest . Non ± surgical management  Colchine (toxic natural product)  NSAID (Indomethacin)  Uricosuric agents (Probenecid) ± to correct hyperuricemia. Surgical management  Incision and drainage of tophi  Joint replacement c.

Prednisone) E ± Exercise is vital to reduce the possibility of the attacks of gout T ± cold/warm therapy H ± Assess and monitor flare ups of gout. avoid foods high in purines like anchovies. Colchicine. avoid consumption of alcohol. roasted highland legumes. treat or diagnose complications of gout D ± increase oral fluid intake.Discharge Planning M ± Depends on the signs and symptoms exhibited by the client (NSAIDS. stress compliance to treatment plan to prevent complications and to reduce pain O ± Regular visit to the physician to monitor gout attacks and to prevent. asparagus. liver. sardines. mackerel S ± Prayer increases patient¶s positive attitude toward treatment regimen . grain meats.

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