Gout

Definition Of Gout

• a heterogenous group of conditions related to a genetic defect of purine metabolism resulting in hyperuricemia
• inflammatory disease of the joints
• mostly affects feet, great toe, ankle & midfoot
• 19 times more common in men
• peak icidence between 20 – 40 years old
• Chronic Polyarticular Gout – final, unremitting stage of the disease marked by persistent, painful polyarthritis

Causes

• Decreased renal excretion of uric acid
• Genetic defect in purine metabolism
• Hereditary factors
• Oversecretion of uric acid
• Radical dieting practices that involve starvation
• Secondary gout associated with drugs
• Secondary gout associated with other diseases:

• Diabetes Mellitus
• Hypertension
• Leukemia
• Myeloma
• Obesity
• Polycythemia
• Renal disease
• Sickle Cell Anemia

Complications

• Renal Calculi
• Atherosclerotic disease
• Cardiovascular lesions
• Stroke
• Coronary Thrombosis
• Hypertension
• Infection with tophi rupture

Assessment

History

• Sedentary lifestyle
• Hypertension
• Renal calculi
• Waking during the night with pain in great toe
• Alcohol ingestion
• Initial moderate pain that grows intense
• Chills, mild fever

Physical Findings

• Severe pain in great toe – early symptom
• Swollen, dusky red or purple joint
• Limited movement of joint
• Tophi, especially in the outer ears, hands & feet
• Skin over tophi that may ulcerate & release chalky white exudate or pus
• Secondary joint degeneration
• Erosions, deformity & disability
• Warmth over joint
• Extreme tenderness
• Low grade fever
• hypertension

3 Clinical Stages

• asymptomatic hyperuricemia – serum urate level is elevated but arthritic symproms, tophi, & renal  stones are not present; may persist  throughout life
• acute gouty arthritis – attacks develop with increased serum urate concentrations; tends to occur with sudden or sustained increases of hyperuricemia but can also be triggered by trauma, drugs, and     alcohol
• tophaceous gout – 3rd & chronic stage of the disease; can begin as early as 3 years or as late as 40  years after the initial attack of  gouty arthritis.

PATHOPHYSIOLOGY

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