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Gout
Gout
Gout
• The most common cause of inflammatory arthritis in US adults
(3.9% of Americans; approx. 8.3 million people; 2007-2008)
• Prevalence is greater in men (5.9%; 6.1 million) than women (2.0%;
2.2 million)
• Prevalence has increased by 1.2% points over the past 2 decades
• Incidence of gout 2x greater among black men than white men
• Men with gout have been shown to have an increased risk of all-
cause mortality and cardiovascular disease mortality
• Cost: 2.3 million ambulatory care visit annually from 2001-2005;
multiple hospitalizations; $7.7 billion attributable to gout between
2005-2011
Pathophysiology
• Caused by the deposition of monosodium urate crystals in
tissues
• Uric acid is a metabolic by-product of purine catabolism
• Purineshypoxanthinexanthineuric acid
• Reaction catalyzed by xanthine oxidase, found in the liver
• When the balance of dietary intake, synthesis and rate of
excretion are disrupted, hyperuricemia results
– Overproduction (10%)
– Underexcretion (90%)
• Results in arthritis, soft tissue masses, nephrolithiasis and
urate nephropathy
Pathophysiology
• Characterized by chronic
arthritis and tophi, resulting
in chronic inflammatory and
destructive changes
Renal Complications
• Nephrolithiasis
– Risk factors: increase uric acid excretion, reduced urine
volume, and low urine pH