Gout



Gout:

UA Pathogenesis:


AAA
IIHX
XXX
GGG


Mechanism of Inflammation in Gout
 
  • Types of Gout
    • Acute Gouty Arthritis 
    • Intercritical or IntervalGout  
    • Recurrent Gouty Arthritis or Chronic Tophaceous gout 

Acute Gout Attack
2012 ACR Guidelines for Management of Gout. Part 2: Therapy and Antiinflammatory Prophylaxis of Acute Gouty Arthritis

  • Diagnosis: 
    • YeLLow light - ParaLLeLL when light passes through the crystal
    • If acute, unless able to rule out Septic arthritis with reasonable certainty, will need Arthrocentesis
    • If Interval or Recurrent - Confirm the diagnosis of Gout - know the DDx - Classify patient on etiology of hyperuricemia (Primary vs. Secondary - overproduction / under excretor) 
Gout BMJ 2013





 
https://www.acponline.org/system/files/documents/about_acp/chapters/.../siaton.ppt

https://www.acponline.org/system/files/documents/about_acp/chapters/.../siaton.ppt


  • Interval gout and Tophaceous gout
    • urate lowering drug plus colchicine or prednisone
Figure 2. Management Strategies in Patients with Hyperuricemia. NEJM 2011


Management Principle



 
https://www.acponline.org/system/files/documents/about_acp/chapters/.../siaton.ppt

  
https://www.acponline.org/system/files/documents/about_acp/chapters/.../siaton.ppt

https://www.acponline.org/system/files/documents/about_acp/chapters/.../siaton.ppt


9 possible Case Scenarios

Pharmacological ULT escalation in 9 such clinical scenarios



URICOSURIC AGENTS








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