The document discusses gout, a type of arthritis caused by uric acid crystals in the joints. It defines gout, lists its symptoms such as sudden severe pain in joints like the big toe, and describes its typical progression from asymptomatic to acute attacks to a chronic condition if left untreated. Risk factors include being male, obesity, diet high in purines, and certain medications. Diagnosis involves examining synovial fluid for uric acid crystals. Treatment focuses on relieving acute attacks, preventing future attacks by reducing uric acid levels in the blood long-term through medications and diet changes, and managing chronic complications through continued medical care.

1. GOUT
The Disease Of Kings
Presented By
Sriloy Mohanty
B.N.Y.S
S-VYASA University

2. Contents…
Introduction
Definition
Epidemiology
Symptoms
Causes
Risk factors
Diagnostic procedure
Treatment protocol
Treatment by natural modalities
Research articles
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3. Introduction
Gout comes from Latin gutta and old French
gote meaning "a drop."
Several hundred years ago gout was thought to
be caused by drops of viscous humors that
seeped from blood into the joints
Gouty arthritis in one or more joints (but less
than four)
May be precipitated by trauma, surgery, alcohol
ingestion, or infection
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4. Definition
It can be defined as the pathological reaction of
the joint or periarticular tissues to the presence
of monosodium urate monohydrate crystals
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5. Epidemiology
• About 10% of people with hyperuricemia
develop gout at some point in their lifetimes
• Depending on the degree of hyperuricemia
▫ When levels are between 415 and 530 μmol/l (7
and 8.9 mg/dl), the risk is 0.5% per year
▫ while in those with a level greater than 535 μmol/l
(9 mg/dL), the risk is 4.5% per year.
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6. The Four Stages of Gout
• Asymptomatic
• Acute
• Intercritical
• Chronic
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7. ASYMPTOMATIC
• A- meaning without indicates that there are
no symptoms associated
• Patient will be unaware of what is happening
• Gout can only be determined with the help of
a physician
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8. ACUTE
• Sever and sudden onset
• Involve one or a few joints
• Frequently starts
nocturnally
• Joint is warm, red, and
tender
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9. INTERCRITICAL
• More concentration
of uric acid crystals
• Typically no need for
drug intervention at
the time.
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10. CHRONIC
• Continuous or
persistent over a long
period of time
• Treatment required
• Not easily or quickly
resolved
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11. Clinical Manifestations
Onset usually nocturnal, with sudden swelling and
excruciating pain
Joint pain usually begins over 2–4 hours and
during the night
May have low grade fever
Usually subsides within 2-10 days
Joints are normal, with no symptoms between
attacks
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12. Other Symptoms
• the heels, knees, wrists, and fingers, may also be
affected
• The reason for onset at night is due to the lower
body temperature
• Other symptoms may rarely occur along with the
joint pain, including fatigue and a high fever
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13. Causes
• Diet
• Genetic predisposition (SLC2A9, SLC22A12, and ABCG2)
• Under excretion of urate (90%)
• The salts of uric acid
• Insulin resistance
• Regular aspirin and niacin use
THE MAIN CAUSE IS THE IMBALANCE BETWEEN THE
INTAKE AND EXCREATION.
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14. Risk factors
• Males after the age of 20
• Female after menopause
• High BMI
• Diet rich in seafood
• HTN
• Thiazide diuretics
• Excess alcohol use
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15. Pathophysiology
Uric acid is end product of purine metabolism
and is excreted by the kidneys
Hyperuricemia
Diet high in purines will not cause gout, but may
trigger an attack in a susceptible person
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17. Complications
Joint deformity
Osteoarthritis
Tophi may produce draining sinuses that may
become infected
Renal stones, pyelonephritis, obstructive renal
disease
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18. Tophi-(Solid urate deposits in tissues)
Gross appearance of tophi X-ray view of a tophi
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19. Diagnosis
History & physical examination
Clinical symptoms alone are sufficient to make
accurate DX in most cases
Family history of gout
Diagnostic studies
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20. Diagnostic Studies
Serum uric acid levels
420 μmol/l (7.0 mg/dl) in males and 360 μmol/l
(6.0 mg/dl) in females
WBC elevated during acute attack
ESR
24 hour urine uric acid levels
Synovial fluid aspiration contains uric acid crystals
 Seldom necessary
X-rays appear normal in early stages; tophi appear
as eroded areas of bone
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21. SYNOVIAL FLUID ANALYSIS
(Polarized Light Microscopy)
The Gold standard
Crystals intracellular during attacks
Needle & rod shapes
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22. Treatment protocol
Acute attack
Colchicines produces dramatic anti-inflammatory
effects with relief within 24-48 hours
NSAIDs for additional pain relief
Corticosteroids (intra-articular)
Adrenocorticotropic hormone (ACTH)
Joint aspiration to decompress
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23. Prevention of acute attacks
Colchicine combined with:
Allopurinol (zyloprim, alloprim) – blocks
production of uric acid
Probenecid (benemid), sulfinpyrazone (anturane) –
inhibit tubular reabsorption of uric acid
Febuxostat (uloric) – inhibits xanthine oxidase,
recently shown to reduce serum uric acid levels
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24. Dietary measures
Weight reduction
Avoidance of alcohol
more low-fat dairy products
Avoidance of foods high in purines
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High: mussels, liver, kidney, meat soups, sweetbreads, beer & wine
Moderate: Chicken, salmon, crab, mutton, pork, beef, ham
Vitamin C intake of 1,500 mg per day decreases the risk of gout
by 45%
Coffee, but not tea, consumption is associated with a lower risk
of gout

25. What we can eat without fear
 Bread (white) and crackers
 Butter or margarine (in moderation)
 Cake and cookies
 Carbonated beverages
 Cereals
 Cheese
 Chocolate
 Coffee
 Cream (in moderation)
 Custard
 Eggs
 Fats (in moderation)
 Fruit
 Gelatin desserts
 Herbs
• Ice cream
• Milk
• Noodles
• Nuts
• Oil
• Olives
• Pickles
• Pasta
• Popcorn
• Puddings
• Relishes
• Rice
• Salt
• Sugar and sweets
• Tea
• Vegetables (except those mentioned
in the first group)
• Vinegar
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26. Home remedy
Raise and rest your limb
Use a splint to immobilize the joint
Do not do vigorous exercise
apply an ice pack or bag of frozen vegetables wrapped in a towel
Do not cover the joint.
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27. Acupuncture
• Sedative points- gv-20,
• Homeostasis point-Li-11
• Analgesic point- st-44
• Immune mechanism- Du-14, Sp-6, St-36
• Influential point-UB-17, UB-11
• Point for Pruritis-Sp-10,UB-16
• Some local points
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28. Thank You

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