Chapter VI - Bone Pathology

Arthritis & Gout

Gout
Gout is a form of arthritis caused by the accumulation of uric acid crystals in joints. It is an intensely painful
disease, which in most cases affects only one joint (monoarthritis), most commonly the big toe. Gout is a metabolic
disorder, which primarily occurs in males. Gout is mainly hereditary in nature. The depositions of these crystal
urates are known as tophi.

Signs and Symptoms

The classic picture is of excruciating and sudden pain, swelling, redness, warmness and stiffness in the joint. Lowgrade fever may also be present. The patient usually suffers from two sources of pain. The crystals inside the joint
cause intense pain whenever the affected area is moved. The inflammation of the tissues around the joint also
causes the skin to be swollen, tender and sore even if it is slightly touched. For example, a blanket draping over
the affected area would cause extreme pain.

The doctor diagnoses the presence of gout by the appearance of the afflicted joint and by the description of the
symptoms by the patient. Definitive diagnosis is made by examining a sample of the joint fluid under a microscope
and along with demonstration of hyperuricemia.

Stages of gout

Gout has four distinct stages:


Asymptomatic

Intercritical

Chronic

Acute

Treatment is by administering colchicine either IV or orally. Other drugs prescribed are diclofenac, phenylbutazone,
probenecid, sulindac, and indomethacin. Acute attacks of gout can be prevented by administering sulfinpyrazone or
allopurinol (Lopurin or Zyloprim).
Surgery
For extreme cases of gout, surgery may be necessary to remove large tophi and correct joint deformity.

Diet
Low purine diet

To lower uric acid:

Cherries have been shown to reduce uric acid

to dilute and assist excretion of urates. When cartilage. fish. causing uric acid to concentrate in the blood which can then easily precipitate) Sweetbreads. Arthritis can be caused from strains and injuries caused by repetitive motion. Rheumatoid arthritis. especially water. Arthritis. or inflammation of the joints. tea and alcohol. osteoarthritis largely affects older people and results from the degeneration of joint cartilage. is eroded at a rate faster than the body can repair. which is generally worse in the morning and on initiating movement. and falls. Avoid entirely during a flare up. on the other hand. can develop because of aging. brains. Unlike the autoimmune diseases. heart. Other forms are discussed below. or infections. The increased sensitivity is thought to be caused by the affected joints developing extra nerve endings in an attempt to protect the joint from further damage. overexertion. or tofu to 8 ounces a day. high in DNA  Sardines  Anchovies  Scallops  Alcohol.  Meat extracts. is systemic and affects the blood vessels. sports. wear and tear. vitamin C. Strawberries or blueberries (and other dark red/blue berries) are also reputed to be beneficial  Celery extracts (celery or celery seed either in capsule form or as a tea) is believed by many to reduce uric acid levels (although these are also diuretics). and resolves in the . and other organs. Signs All arthritides feature pain. poultry. this is known as arthritis. kidneys.  Use sparingly diuretic foods or medicines like aspirin. that is. the tough fibrous material covering the ends of the bone. consommés. especially beer because brewer's yeasts are very rich in purine (alcohol may also reduce the rate of uric acid excretion). Food to avoid:   Foods high in purines. or other offal meats To avoid dehydration:  Drink plenty of liquids. Osteoarthritis or degenerative joint disease is the most common type of arthritis. Arthritic joints can be sensitive to weather changes. liver.  Limit food high in protein such as meat. and gravies  Diet sodas (these act as diuretics in many people.

calcium. Blood tests and X-rays of the affected joints are often performed to make the diagnosis. reduction of joint stress. and other clues. the age and sex of the patient. In elderly people and children. Raynaud's phenomenon.   Pierre Marie-Bamberger syndrome (hypertrophic pulmonary osteoarthropathy. and drug treatment. additional symptoms such as psoriasis. phosphate. and the patient simply moves less (elderly) or refuse to use the affected limb (children). and pain management. Types of arthritis Primary forms of arthritis: Secondary to other diseases: Diseases that can mimic arthritis: Diagnosis The various types of arthritis can be distinguished by the pace of onset. physical and occupational therapy. antinuclear factor (ANF). renal function. iridocyclitis. extractable nuclear antigen and specific antibodies whenever the ANF is found to be positive. Specific tests are the rheumatoid factor. protein electrophoresis. C-reactive protein and the erythrocyte sedimentation rate (ESR). liver enzymes. a paraneoplastic phenomenon of lung cancer) Multiple myeloma  Osteoporosis  Henoch-Schönlein purpura  Psoriatic arthritis  Reiter's syndrome  Reactive arthritis  Hemochromatosis  Hepatitis . the pain may not be the main feature. Treatment Treatment options vary depending on the precise condition. the amount of (and which) joints affected. and rheumatoid nodules. but include surgery. Screening blood tests: full blood count. X-rays can show erosions or bone appositions.course of time. electrolytes.

 Rheumatoid arthritis  Osteoarthritis  Gout and pseudogout  Juvenile arthritis  Still's disease  Ankylosing spondylitis  Arthritis  Systemic lupus erythematosus (SLE) Septic arthritis . Wegener's granulomatosis (and many other vasculitis syndromes)  Familial Mediterranean fever (FMF). HIDS (hyperimmunoglobulinemia D and periodic fever syndrome) and TRAPS (TNF-alpha receptor associated periodic fever syndrome).