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GOUT
Prof. Dr. Shah Murad
shahmurad655@yahoo.com
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GOUT
also called crystal-induced arthritis, is an
arthritic condition that occurs when uric
acid crystals accumulate in the joints.
Gout usually affects the large joint of the
big toe, but can also affect other joints,
such as the knee, ankle, foot, hand, wrist
and elbow.
In rare cases, it may later affect the
shoulders, hips or spine.
Gout does not spread from joint to joint.
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Uric acid is a substance that normally
forms when the body breaks down waste
products (called purines).
Uric acid is usually dissolved in the blood
and passes through the kidneys into the
urine.
For people with gout, the uric acid level in
the blood is so high that uric acid crystals
form and deposit in joints and other
tissues. This causes the joint lining to
become inflamed, resulting in sudden and
severe attacks of pain, tenderness,
4
Afterseveral years, the crystals can build
up in the joints and surrounding tissues,
forming large deposits, called tophi.
6
Although the exact cause is
unknown, gout may be caused
by
genetic defect in metabolism, which causes
overproduction and retention of uric acid
kidney impairment that prevents normal
elimination of uric acid
thiazide diuretic medications (water pills) used
to treat high blood pressure and heart failure
diseases of the blood cells and blood-forming
organs, certain cancers and psoriasis
environmental factors, such as obesity, alcohol
abuse and a purine-rich diet. 7
An episode of gout can be
triggered by:
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Symptoms of Gout
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Intercriticalstage - symptom-free
intervals between gout episodes.
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(4) Chronic stage
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Diagnosis of Gout
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MANAGEMENT
Proper diet
Avoid or restrict foods high in purine (a
substance that produces uric acid when
broken down).
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Usingmedications for gout can be
complicated, because the treatment
needs to be tailored for each person
and may need to be changed from time
to time.
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Colchicine
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COLCHICINE
It is used to treat acute flares of gouty arthritis
and to prevent recurrent acute attacks.
21
Colchicineinhibits microtubule
polymerization by binding to tubulin,
one of the main constituents of
microtubules.
24
Long term (prophylactic) regimens of oral
colchicine are absolutely contraindicated
in patients with advanced renal failure
(including those on dialysis).
10-20% of a colchicine dose is excreted
unchanged by the kidneys.
Colchicine is not removed by
hemodialysis.
Cumulative toxicity is a high probability in
this clinical setting. A severe
neuromyopathy may result. The
presentation includes a progressive onset
of proximal weakness, elevated creatine 25
Colchicinetoxicity can be potentiated by
the concomitant use of cholesterol
lowering drugs (statins, fibrates).
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Toxicity
Colchicine poisoning has been compared to
arsenic poisoning: symptoms start 2 to 5 hours
after the toxic dose has been ingested and
include burning in the mouth and throat, fever,
vomiting, diarrhea, abdominal pain and
kidney failure.