Please enable JavaScript.
Coggle requires JavaScript to display documents.
Gout Goutforweb500pxw - Coggle Diagram
Gout
What's Gout?
Gout is a common type of arthritis that causes intense pain, swelling, and stiffness in a joint. It usually affects the joint in the big toe.
Gout is a form of arthritis caused by excess uric acid in the bloodstream.
The symptoms of gout are due to the formation of uric acid crystals in the joints and the body’s response to them.
Gout most classically affects the joint in the base of the big toe.
Gout attacks often occur without warning in the middle of the night.
Most gout cases are treated with specific medications.
It is the most common form of inflammatory arthritis in men, and although it is more likely to affect men, women become more susceptible to it after the menopause.
The Centers for Disease Control and Prevention (CDC) report that 8.3 million Americans were affected by gout between 2007 to 2008.
Symptoms
Pain
Rapid onset
Symptoms interrupt sleep
Swelling
Heat
Redness
Causes and Risk Factors
Diet.
foods high in purines, including meats, seafood, certain vegetables and beans, and foods containing fructose.
Alcohol use. Drinking alcohol decreases the body's ability to flush out uric acid. Additionally, beer is made with brewer's yeast, which is high in purines.
Gender. Men are more likely to have gout. Women are less likely to get gout, however, their risk of developing gout increases after menopause.
Age. Many people have their first episode of gout between the ages of 30 and 50, and the risk of gout continues to increase with age. It is estimated that nearly 12% of men aged 70 to 79 have had gout while less than 3% of men under the age of 50 have had it.
Excess weight. People who are overweight have a greater risk of developing gout.
Race. African American men are nearly twice as likely to report having had gout as Caucasian men, according to a study cited by the Centers for Disease Control and Prevention.11
Family history. Genetics plays a role, making some people’s bodies more prone to accumulating uric acid and developing the uric acid crystals that lead to gout. More research needs to be done to understand why some people have several risk factors and never get gout while other people have few or no risk factors and do get gout.
Certain medications. Taking certain medications can increase the risk of gout. Some of these medications include:
Maedications
• Diuretics, sometimes called "water pills"
• Aspirin
• Cyclosporine, an immunosuppressant sometimes prescribed to people who have rheumatoid arthritis or psoriasis, or who have had an organ transplant
• Levodopa, often used to treat Parkinson's disease
Chronic renal failure. A person who has chronic renal failure no longer has fully functioning kidneys. When the kidneys’ ability to flush out uric acid is compromised, gout may develop.
Lead exposure. People who are exposed to lead in the environment have a higher incidence of gout. Though much less common today, gout caused by lead exposure was common years ago when people unwittingly drank from leaded crystal glassware.
A trigger event, such as injury, surgery, or medical therapy. Specific events can trigger a change in body chemistry and bring on a gout flare up. Such events include, but are not limited to, infection, trauma, surgery, psoriasis, and the initiation of chemotherapy. Stopping or starting allopurinol, which is used to treat gout, can also bring on gout symptoms.
Acquired Causes of Hyperuricemia
Increased urate production
Nutritional: Excess purine, ethanol, fructose consumption
The Purine Content of Foods and Beverages
High
Best to avoid:
Liver, kidney, anchovies, sardines, herring, mussels, bacon, codfish, scallops, trout, haddock, veal, venison, turkey, alcoholic beverages
Moderate
May eat occasionally:
Asparagus, beef, bouillon, chicken, crab, duck, ham, kidney beans, lentils, lima beans, mushrooms, lobster, oysters, pork, shrimp, spinach
Low
No limitation:
Carbonated beverages, coffee, fruits, breads, grains, macaroni, cheese, eggs, milk products, sugar, tomatoes and green vegetables (including lettuce and excluding vegetables listed above)
Hematologic: Myeloproliferative and lymphoproliferative disorders, polycythemia
Drugs: Ethanol, cytotoxic drugs, vitamin B12 (treatment of pernicious anemia)
Miscellaneous: Obesity, psoriasis, hypertriglyceridemia
Decreased renal excretion of urate
Drugs: Ethanol, cyclosporine (Sandimmune), thiazides, furosemide (Lasix) and other loop diuretics, ethambutol (Myambutol), pyrazinamide, aspirin (low-dose), levodopa (Larodopa), nicotinic acid (Nicolar)
Renal: Hypertension, polycystic kidney disease, chronic renal failure (any etiology)
Metabolic/endocrine: Dehydration, lactic acidosis, ketosis, hypothyroidism, hyperparathyroidism
Miscellaneous: Obesity, sarcoidosis, toxemia of pregnancy
Drugs
NSAIDS: Contraindicated in patients with peptic ulcer disease or systemic anticoagulation; side effects include gastropathy, nephropathy, liver dysfunction, central nervous system dysfunction and reversible platelet dysfunction; may cause fluid overload in patients with congestive heart failure
Indomethacin (Indocin) 25 to 50 mg four times daily
Naproxen (Naprosyn) 500 mg two times daily
Ibuprofen (Motrin) 800 mg four times daily
Sulindac (Clinoril) 200 mg two times daily
Ketoprofen (Orudis) 75 mg four times daily
Colchicine 0.5 to 0.6 mg orally every hour until relief or side effects occur, or until a maximum dosage of 6 mg is reached
Dose-dependent gastrointestinal side effects; improper intravenous dosing has caused bone marrow suppression, renal failure and death (see text)
Corticosteroids
Oral
Prednisone, 0.5 mg per kg on day 1, taper by 5.0 mg each day thereafter
Fluid retention; impaired wound healing
Intramuscular
Triamcinolone acetonide (Kenalog), 60 mg intramuscularly, repeat in 24 hours if necessary
May require repeat injections; risk of soft tissue atrophy
Intra-articular
Large joints: 10 to 40 mg
Preferable route for monoarticular involvement
Small joints: 5 to 20 mg
ACTH
40 to 80 IU intramuscularly; repeat every 8 hours as necessary
Juvenile Gouty Arthritis
Juvenile gouty arthritis is a rare but distinct entity seen in Childhood and adolescence and results from hyperuricemia associated with mild renal insufficiency.
Risk factors
Link Title
Purine over-ingestion
Metabolic syndromeethanol use
Renal insufficiencyFilipino ancestry
Psoriasis
Myeloproliferative and Lymphoproliferative Disorders
Chronic lead poisoning
DehydrationThe postoperative state
Critical illness with metabolic acidosis
Sarcoidosis
Hyperparathyroidism
Ketosis
Polycystic kidney disease
Down syndrome
Hypoxanthine-guanine phosphoribosyl-transferase deficiency(Lesch–Nyhan syndrome when homozygous)
Phosphoribosylpyrophosphate synthetase overactivity
Glucose-6-phosphatase deficiency (von Gierke’s disease)
Fructose 1-phosphate aldolase deficiency
Podiatry Management
Link Title
