 Definition of Gout  Pathological classification  History of Gout  Gout Aetiology & Pathogenesis  Clinical management of Gout patients

 Gout is a type of arthritis  Gout results from an inflammatory response to build up of Uric acid in blood  Progresses to Urate crystals in joints  Urate crystals erode articulating surfaces of bone

 An inherited metabolic disease  Acute of Chronic Acute Chronic Sudden Onset Short term symptoms Can resolve without treatment Can progress to chronic Gout Recurring problem Insufficient resolution between attacks Cartilage/bone destruction results

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Acute Gout

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Chronic Gout

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http://www.bpac.org.nz/magazine/2007/septemb er/gout.asp?page=2

Discovered in 2640 BC by Egyptians http://kimba63.files.wordpress.co

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460-370 BC Hippocrates described Gout as an acute inflammation of 1 st MTP joint http://personal.georgiasouthern.ed

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129-200 AD Galen described Tophi. Galen recognised hereditary nature of Gout http://www.iep.utm.ed

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More likely to suffer Gout

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Less likely to suffer Gout

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Most often affects

 Gout appears as radiolucent bone erosions around joints  Soft tissue swelling and inflammation present http://www.bpac.org.nz/magazine/2007/september/images/gout_ xray_bpac.jpg

http://www.learningradiology.com/archives06/COW%20227 Gout-elbow/goutelbowcorrect.html

 Gout results from a build up of Uric acid  Uric acid results from metabolism of Purines  High blood uric acid levels can be due to a Purine-rich diet or kidney insufficiency

 The nephron  Higher incidence of Gout in males as Oestrogen assists renal clearance of uric acid

 Excess uric acid levels decrease solubility  This leads to crystalization  Urate deposits are covered with proteins as part of immune response forming Tophi  Tophi are the cause of bone erosion http://www.hopkinsarthritis.org/wp content/uploads/2011/04/gout_fig7.gif

 Treatment is in two stages   Minimization of the acute inflammation Prevention of future attacks • Acute attacks are managed with drugs. They last 1-2 weeks • Chronic conditions are treated by lowering uric acid levels through exercise, weight loss, diet changes

 Patient history & physical examination  Arthrocentesis test  Blood/Urine analysis  X-ray studies

Focus will be on  Family history  Recent trauma  Patient’s lifestyle & diet

 Test involves aspirating synovial fluid from affected joint  Fluid is examined for urate crystals  Performed when diagnosing chronic Gout

 Performed to assess uric acid levels when Gout diagnosis is unclear

 Performed mainly in later stages of Gout

 Patient had pain, swelling, deformities of 1 st MTP joints.

 Swelling around 3 rd MCP joint in both hands

 MRT contact with Gout patients is usually in later stages of disease  Be mindful positioning as the patient may be in pain

Anton, F., Garcia, J., Ramos, T., Gonzalez, P., Ordas, J. (1986). Sex Differences in Uric Acid Metabolism in Adults.

Metabolism: Clinical and Experimetal

, 35(4), 343-8. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/3959904 Dalbeth, N. (2006). The Pathway from Gout to Bone Erosion. Retrieved from http://www.hrc.govt.nz/sites/default/files/HRC69%20(Dalbeth).pdf

Doherty, M. (2009).

New Insights into the Epidemiology of Gout

. Oxford Rheumatology Journal, 48:ii2 –ii8. doi:10.1093

Eustice, C. (2012). Cut Back Purine-Rich Foods with Gout. Retrieved from http://arthritis.about.com/cs/goutdiet/a/goutpurines.htm

Gout. (2012). Retrieved from http://www.healthinplainenglish.com/health/musculoskeletal/gout/index.htm

Gout: Exams and Tests. (2010). Retrieved from http://arthritis.webmd.com/tc/gout-exams-and-tests Kowalczyk, N., Mace, J. (2009).

Radiographic Pathology for Technologists

(5 th ed.) St. Louis, Missouri: Mosby Elsevier Mandell, B. (2008). Clincal Manifestations of Hyperuricemia and Gout.

Cleveland Clinical Journal of Medicine

, 75(5). Retrieved from http://ccjm.org/content/75/Suppl_5/S5.full.pdf

Manno, R. (2012). Clinical Features of Gout. Retrieved from http://www.hopkinsarthritis.org/arthritis-info/gout/clinical presentation-of-gout/ Marieb, E., Hoehn, K. (2007).

Human Anatomy & Physiology

(7 th ed.). San Francisco, CA: Pearson Benjamin Cummings

Nuki, G., Simkin, P., (2006). A Concise History of Gout and Hyperuricemia and their Treatment.

Journal of Arthritis Research and Therapy 2006,

8(1), doi:10.1186/ar1906 Stoppler, M. (2012). Gout. Retrieved from http://www.medicinenet.com/gout/page2.htm

Taylor, K. (2012). Uric Acid Crystals. Retrieved from http://www.goutpal.com/uric-acid/uric-acid-crystals/ Teitel, A. (2011). Gout. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001459/ Zare, F., Magnusson, M., Bregstrom, T., Brisslert, M., Josefsson, E., Karlsson, A., Tarkowski, A. (2006). Uric Acid, a nucleic acid degredation product, down-regulates dsRNA-triggered arthritis.

Journal of Leukocyte Biology

, 79(3), 482 4. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16387838

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Rouse Educational Trust

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Pauline Hext