called tophi. and presumably on inadequate capacity for its excretion.A metabolic disturbance in which little masses of Na rate crystals. INCIDENCE: men beyond middle life . Defects of purine metabolism resulting from overproduction of uric acid in gouty subject. become deposited in the vicinity of the joints.

Tophi. . including the cartilaginous tissues.small white nodules .also in synovial fluids. .concentration of the uric acid is high in the blood because of its low solubility precipitate in the form of deposits at various sites where blood flow is least active.

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Ears 3. Knuckles 4. great toe or ankle 2. Knees .Sites of Urate crystal affection: 1.

Diabetic ketacidosis 5. Starvation 4. diuretics 6. Chronic Renal Disease 2. HPN 3. salicytate .What can interfere with uric acid secretion? 1.

uric acid. such as proteoglycans. . including trauma. which breaks down uric acid. collagens. and extracellular matrix proteins. rapid changes in uric acid levels. on tendons. precipitating in joints. acidosis. crystallizes in the form of monosodium urate.Pathophysiology Gout is a disorder of purine metabolism. and chondroitin sulfate. and stopping or starting allopurinol. Other factors believed to be important in triggering an acute episode of arthritis include cool temperatures. surgery. The increased precipitation at low temperatures partly explains why the joints in the feet are most commonly affected. chemotherapy. it is more likely to do so as levels increase. The triggers for precipitation of uric acid are not well understood. Rapid changes in uric acid may occur due to a number of factors. These crystals then trigger a local immunemediated inflammatory reaction with one of the key proteins in the inflammatory cascade being interleukin 1β. An evolutionary loss of uricase. and occurs when its final metabolite. While it may crystallize at normal levels. in humans and higher primates is what has made this condition so common. and in the surrounding tissues. articular hydration. diuretics.

sensitive joimys 3. fatty acid 2. . may even disappear but the following night returns and so one for 5-8 days. agonizing pain usually begins in the early morning.Predisposing Factors 1. hot . red. in the first joint of the big toe and later in other joints of the foot. 2. ingestion of ethyl alcohol Signs and Symptoms: 1. (inflamed joints) swollen. Fever  Later in the morning pain abates.

Skin disease (eczema) 7. Tophi develops 2. Symptoms of chronic nephritis 8. GIT disturbance with pain 3. Chronic Gouty Arthritis Signs and Symptoms 1. Vomiting 4.Attacks usually recur often with intervals of some months. Constipation 6. “chalk stones” – ulceration formed on the knuckles consisting of uric acid . Diarrhea 5.

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Increase uric acid in the blood – 5mg/100ml or over.Diagnostic Examination 1. urea. Increase WBC and ESR . creatinine of the plasma shows renal decomposition. a uric acid retention caused by failure of the diseased kidney to excrete this material. Presence of Tophi in the skin – ascertain by aspiration of crystals of Na urate 2. X-ray of the joint 3. 4. An increase uric acid.

5.Medical management 1.Peptic ulcer  .1.) Colchine – 0.) Phenylbutazone (Butozolidin)200 mg 4x a day – reduces fever.0 mg given at 2 hours intervals for a total dose of 6-10mg b.) corticosteroid drugs ( Prednisone) c. Serious complications includes: -bone marrow depression . Drug Therapy a. eliminates inflammation with in a period of 48 hours.

beans.drugs that promote excretion of uric acid in the urine.5 daily .g. spinach. oatmeal.5-1. kidney. . Long-term Management a. peas.) Limited intake of purine bases e.) Uricosuric agents . liver.Benemid – 0. seafood's) b.2.200-800mg daily -these should not be taken with salicylates since they antagonize each other. sardines. shellfish. mushrooms.Anturone. anchovies. . -increase fluid – to prevent precipitation of urine crystals. meat extracts. peanuts.

6. 2. Position the joints in semi flexion (this decrease intra-articular pressure and promote comfort) 3. Urinalysis data be charted promptly. Administer anti-gout meds as ordered 7. Bed rest and joint immobilization as ordered. . Anlagesics as ordered. Hot and cold application 4.Nursing intervention: 1. Increase fluids 2000-3000 ml/day to prevent renal calculi 5.

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