Pathophysiology of Gout:

Pathophysiology of Gout – It is a disease in which defective metabolism of uric acid causes arthritis, especially in the smaller bones of the feet, deposition of chalk-stones, and episodes of acute pain.

 

What is Gout?

Gouty Arthritis is a defect in the ability of the body to rid itself of excess uric acid, thus causing uric acid crystals to lodge in the collagen tissue matrices throughout portions of the body, especially near the joints, or at other locations where a supersaturated solution of poorly dissolved uric acid will easily fall out of solution, near cooler portions of the body.

Causes for Gout:

Although the exact mechanisms for the production of Gout are not entirely understood.

Many factors may be involved, including decreased urine produc- tion, and other conditions associated with decrease of fluids external to cells.

May be the renal disease, dehydration, diabetes, the use of diuretics, starvation, acute alcohol ingestion, toxemia of pregnancy, and over production of lactic acid.

Damage to nerves from lead poisoning has been suggested as a mechanism for Gout.

The use of various drugs may contribute to Gout, such as pyrazinamide, aspirin (salicylates), ethambutol, diuretics, and nicotonic acid.

Symptom of Gout:

  1. The symptoms of gout are that the big toe joint is most frequently affected, but instep, ankle, knee wrist and elbow are common sites, sometimes even the spine.
  2. There may be joint deformation if unattended.
  3. limitation of joint movement.
  4. Sharp, needle-like pain on movement of joints.
  5. Skin is tense, hot, shiny and dusky red or purplish.
  6. Systemic reactions may in- clude fever.
  7. Heart rate increase, and chills and malaise.

 

Classification of Gout:

Gout is classified into primary and secondary “hyperuricemia;” that is, the condition of excess uric acid in the blood stream.

  • Primary Gout refers to genetic deficiencies or disorders.
  • Secondary Gout refers to a gouty condition that follows from another dis- ease, or as the consequence of drug intake.

Acute Gouty Arthritis:

Acute Gouty Arthritis may be the presenting symptom of another under- lying metabolic disorder.

An acute attack usually appears without warning, but may be precipitated by minor trauma, as from minor surgery or ill-fitting shoes, overindulgence in food or alcohol, fatigue, emotional problems, infections, or treatment with antibiotics, insulin or mercurial diuretics.

Systemic reactions may include fever, heart rate increases (tachycardia), chills, malaise and an increase in leukocytes (leukocytosis) in the blood.

 

Interval Gout:

There is typically a complete remission of symptoms, and then most patients experience a second attack from six months to two years later. If they are untreated, the attacks will increase in frequency.

 

Chronic Gout:

A third stage of Gout is reached after many years. With chronic Gout, hard or gritty deposits appear in the joint and tendons.

Chronic joint symptoms develop as permanent erosive joint deformity appears. There is limitation of motion, often involving multiple joints of the hands, feet, or both.

Rarely is the shoulder, scacroiliac or sternoclavicular joints involved. Sometimes the cervical spine may be involved.

Monosodium urate deposits are common in the walls of the sacs surrounding joints (bursae) and within tendon sheaths.

Increasing deposits of monosodium urate about the joints, erosion of joints and joint destruction, chronic joint swelling and pain may progress to a crippling disease in which acute attacks decrease in frequency and severity.

Drugs used in gout are:

  1. For acute gout – NSAIDs, Clochicine, Corticosteroids.
  2. For Chronic gout – Allopurinol, probenecid.

 

Treatment For Gout:

(1) Use of an anti-inflammatory drug to reduce the pain of an acute attack

(2) Daily use of a drug, Colchicine, to dissolve the already deposited crystals.

(3) Use of Allopurinol to prevent further deposition of crystals.

(4) A maintenance program of preventative therapy, usually through diet control.

Diet in Gouty arthritis:

Dr. Murray summarizes the proper dietary regimen as

(1) elimination of alcohol intake;

(2) low purine diet;

(3) achievement of ideal body weight;

(4) liberal consumption of complex carbohydrates;

(5) low fat intake;

(6) low protein intake;

(7) liberal fluid intake.

References:

  1. The Merck Manual of Diagnosis and Therapy, 16th Edition, Merck, Sharp & Dohme Research Laboratories, Division of Merck & , Inc., Rahway, N.J., 1992.
  2. Textbook of Internal Medicine, B. Lippincott Company, East Washing- ton Square, Philadelphia, PA 19105, 1989.
  3. John Baron, O., Gouty Arthritis, The Art of Getting Well, The Arthri- tis Trust of America, 7376 Walker Road, Fairview, TN 37062-8141, 1989.
  4. Burton Goldberg Group, Alternative Medicine: The Definitive Guide, Future Medicine Publishing Co., Puyallup, WA,
  5. Anthony di Fabio, Thyroid Hormone Therapy: Cutting the Gordian Knot, The Art of Getting Well, The Arthritis Trust of America, 7111 Sweetgum SW, Fairview, TN 37062-9384, 1989; a report on the work of Broad Barnes, M.D.