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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