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.
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