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Gout, Incidence/Prevalence, Risk factors, Pathogenesis, Modifiable,…
Gout
Stiffness, swelling, redness, and tenderness in one or more joints
Sudden, severe attacks of pain
Lumps or physical deformity in the joints
These manifestations often present in the big toe.
Feeling like a joint is "on fire"
For men, these symptoms usually appear between 30-50 y/o. For women, they usually begin after menopause.
7.44 million cases have been estimated around the world in 2017 with a prevalence of 41.22 million cases.
"Gout incidence, prevalence, and health loss considerably increased during the last 25 years and are all higher in men than in women."
The incidence of gout increases linearly with aging, until 64 years old.
Total prevalence of gout in children 0-18 years old was 0.040% in 2020. This prevalence was highest in adolescent males.
Total prevalence of gout in adults in the United States is estimated at 3.9%.
Gout is a metabolic disorder that begins with the accumulation of uric acid in blood and tissues. This buildup is known as hyperuricemia, which is characterized by a serum urate level greater than 6.8 mg/dL.
Urate salts then precipitate in the blood and tissues, forming monosodium urate crystals. These needlelike crystals deposit in the synovium, bone, skin, cartilage, tendons, ligaments, and kidney.
Gouty attacks occur with the release of these crystals into the joint space, initiating an inflammatory cascade. This inflammatory response results in acute gouty arthritis. Flares will resolve, but the crystals remain deposited within the joints unless the serum urate level is lowered.
This acute crystal-induced inflammation may turn chronic with the involvement of cytokines, chemokines, proteases, and oxidants. As a result, potential cartilage loss and bone erosion occur.
Rothschild, B. M. (2021, October 17). What is the pathogenesis of gout? Latest Medical News, Clinical Trials, Guidelines - Today on Medscape. Retrieved April 20, 2022, from
https://www.medscape.com/answers/329958-10220/what-is-the-pathogenesis-of-gout
Saag, K. G., & Choi, H. (2006, April 12). Epidemiology, risk factors, and lifestyle modifications for gout - arthritis research & therapy. BioMed Central. Retrieved April 20, 2022, from
https://arthritis-research.biomedcentral.com/articles/10.1186/ar1907
Mattiuzzi, C., & Lippi, G. (2019, December 13). Recent updates on worldwide gout epidemiology - clinical rheumatology. SpringerLink. Retrieved April 20, 2022, from
https://link.springer.com/article/10.1007/s10067-019-04868-9
Pillinger, M. H., & Mandell, B. F. (2020, June 30). Therapeutic approaches in the treatment of gout. Seminars in Arthritis and Rheumatism. Retrieved April 20, 2022, from
https://www.sciencedirect.com/science/article/pii/S0049017220301244
High intake of purine rich foods (red meat, seafood, animal protein)
Obesity
Alcohol consumption
Medications: diuretics, low-dose aspirin, organ transplantation drugs
Environmental: lead exposure
Older age
Race/ethnicity: African Americans have a twofold increased risk.
Sex: Males have a fourfold higher prevalence than women.
Genetics: There is a genetic predisposition for gout through renal urate clearance.
Laboratory tests
Serum uric acid test: detects levels of uric acid in the blood
Joint fluid test: Urate crystals may be visible under a microscope
Uric acid urine test
Imaging tests
Joint X-rays
Ultrasound: sound waves detect urate crystals in joints or in tophi
Dual-energy computerized tomography (DECT): combines x-rays from different angles to visualize crystals within the joints
Medications
NSAIDs (ibuprofen, Aleve): treat inflammation caused by a gout attack
Colchicine: anti-inflammatory drug that reduces gout pain
Corticosteroids (Prednisone): control gout inflammation and pain
Xanthine oxidase inhibitors (Allopurinol): limits amount of uric acid the body makes
Probenecid: improves uric acid removal through kidneys
Lifestyle Remedies
Avoid purine rich foods: Stay away from red meat, organ meats, and seafood
Choose healthier beverages: Limit alcohol and beverages high in fructose
Exercise regularly and lose weight: Choose low-impact activities that are easier on your joints. A healthy weight reduces the risk of gout.
Incidence/Prevalence
Risk factors
Pathogenesis
Modifiable
Nonmodifiable
Sources
Diagnostics
Clinical Manifestations
Treatments