Gout Arthritis

Introduction
• gout is a chronic disease of deposition of monosodium urate crystal,
which form in the presence of increased urate concetration
• it cause inflammation of joints and surrounding tissues
• the prevalence of gout is much higher in men than in women
Etiology
• underexcretion of uric acid
• more common (90%)

• overproduction of uric acid

• less common
• genetic abnormalities in enzyme related purine metabolism : increased
phosphoribosyl pyrophosphate synthetase (PRPP) & decreased hypoxanthine-
guanine phosphoribosyl transferase (HGPRT)
• increased cell turnover (cytotoxic chemotherapy, malignancies)
• increased ingestion of diets rich in purine
Pathophysiology
• once uric acid has passed its saturation point of (6.8 mg/dL; at 37o C,
pH 7.4), it starts to precipitate out in the form of monosodium urate
crystals
• monosodium urate crystals deposit in joints, soft tissues and cartilage
• trigger the inflammatory response
• microcrystals tend to form in cooler areas of the body
Laboratory diagnosis
• synovial fluids
• identification of MSU
• blood test
• plasma uric acid
• WBC count
Treatment
• antiinflammatory drugs (colchicine, prednisolone, indomethacin)
• uricosuric drugs (probenecid)
• xanthine oxidase inhibitor (allopurinol)
Dietary modification
• limiting food high in purine (seafood, red meat)
• limiting alcohol consumption
• maintaining adequate fluid intake