GOUT

Dr. A.MOHAN KRISHNA M.S.ORTHO, MCh ORTH(U.K)Consultant Orthopaedic surgeon ,Trauma, Arthroscopy, Arthroplasty Surgeon Apollo hospitals, Hyderabad

Consultant Orthopedic Surgeon at

www.drmohankrishna.comwww.healthyjointclub.comwww.bonesandjointsclinic.com

This presentation is solely for educational purpose. The material included in the presentation represents educational material for the patients and not intended for any treatment purpose

DISCLAIMER

DESCRIPTION

Gout is a metabolic disease in which crystals of Uric acid (Monosodium urate) gets deposited in joints , tendons and surrounding soft tissues.

CAUSESThe proteins that we consume in our diet get digested and undergo various steps of degradation in our body.

Normal metabolism Purinies Diet

/proteins

Uric acid Rise in levels

Formation of crystals

Crystals collect in joint

Rapid pain, swelling and redness of joint

GOUTElimination from the body:urine/faeces

CAUSESHigh levels of Uric acid can be produced due to

Intake of protein rich diet- high purine diet

Abnormalities in chemical pathways that leads to excessive production of uric acid

Certain drugs like Aspirin (Salicylates), Diuretics (Kidney drugs) interfere with the excretion of uric acid thereby raising its level in blood

SYMPTOMS

Uric acid deposits as crystals in joints and tendons

Monosodium urate crystals

Irritation, Inflammation of joints and tendon tissue

Joints hot/red/swollen

SYMPTOMS

• Big toe of foot: classical location.• Hot/red and swollen

• Ankles• Knee

• Elbows • Joints of hand feet

RISK FACTORS

A protein rich diet./A high alcohol intake

Certain races, like Maoris and Polynesian

Obesity.

Conditions that cause high cell turnover, such as polycythaemia (increased red cells), lymphomas and various other cancers can increase blood uric acid levels.Drugs like Diuretics (drugs increasing urine flow) or low dose salicylates,

Kidney diseases.

DIAGNOSIS: HistorySudden onset of severe pain, swelling and redness of joint in great toe of the foot.

swelling of joints of foot, ankles and hands

History of alcohol or red meat intake a day prior to painful attack

History of similar episodes in the past

DIAGNOSIS : Examination:

Acute stagesLong standing cases: uric acid crystals deposit in tendons and tissues – GOUT TOPHI

INVESTIGATIONSBlood tests• Rise in uric acid

Fluid examination from swelling• Uric acid crystals

X-rays• Long standing cases joint destruction

TREATMENT

NSAID’S : Pain killers in high dose initially to settle

pain and swelling

Colchicine : can be given in acute attack

Newer drugs to reduce level of uric acid in blood

Rest to affected joint during acute phase

Acute attack

DRUG TREATMENT

Given to control levels of uric acid in blood.

To prevent long term complications.

Drug dosage to be adjusted according to levels of uric acid.

Allopurinol is one of the oldest and common drug used to control the levels of uric acid in blood. This drug inhibits xanthine oxidase which converts xanthine into uric acid.

Probenicid and Sulphinpyrazone – Promotes excretion of uric acid through kidneys

PREVENTIONOnce you are diagnosed with Gout, you’re a patient of gout for your life.

Avoid Protein rich diet – High Purine foods

Avoid Dehydration: especially in hot weathers

Avoid unaccustomed strenuous exercise.

Care should be taken in patients on long term diuretics and low dose aspirin.

DIET FOR GOUT

COMPLICATIONS OF UNTREATED GOUT

joint damage (Arthritis),

formation of gout tophi (swellings around the joint) and

rare complication of chronic kidney disease

UNTREATED GOUT PATIENT

CONTACTDr.A.MOHAN KRISHNAM.S.Ortho., MCh Ortho(U.K).,Consultant Orthopaedic Surgeon,Apollo Hospitals,Hyderabad.Appointments: Secretary : 09247258989 09441184590 08332936085 www.drmohankrishna.comwww.healthyjointclub.comwww.bonesandjointsclinic.comEmail: bonesandjointsclinic@gmail.com