The Skeletal System
The term refers to acute or chronic arthritis of peripheral joints that predominantly affects adults males and results from deposition of monosodium urate crystals (derived from hyperuricaemic body fluids) in the joint or tendons and tendon sheaths. Hyperuricaemia is a necessary but not a sufficient prerequisite for clinical manifestations of gout because asymptomatic hyperuricaemia is 10 times more common. Hyperuricaemia is defined as a serum uric acid level above 0.42 mmol/L in adult males and 0.36 mmol/L in adult females.
Solubility of uric acid drops with temperature, so characteristic needle-shaped crystals of monosodium urate are formed in avascular tissues (e.g., cartilage) or relatively avascular tissues (e.g., tendons, ligaments) around cooler distal peripheral joints and cooler tissues (e.g., ears). In severe ling standing gout deposits can be found in other tissues such as the kidney (uric acid stones).
Two mechanisms of hyperuricaemia have been identified:
Clinical features: < BACK TO TOP >
1. Acute gout
joint of a great toe is the site of the first attack of acute gouty
arthritis in 70% of patients.
ankle, the knee, the small joints of the feet and hands, the wrist and elbow
follow in decreasing order of frequency.
onset is usually explosively sudden without warning, often waking the patient
affected joint is hot, red and swollen with shiny overlying skin, it is very
painful and tender; signs resemble acute infection.
acute attacks may be accompanied by fever, chills, tachycardia, leukocytosis
and raised ESR.
untreated, the attack lasts for days or weeks but it eventually subsides
patients have only a single attack, or suffer another only after an interval
of many months or years, but more often there is a tendency to have recurrent
attacks may be precipitated by sudden rises in serum urate following dietary
excess (overindulgence in purine-rich food such as meat), alcohol, diuretic
drugs, reduction of anti-gout therapy, trauma, unusual physical exercise,
surgery or severe systemic illness.
2. Chronic gout
attacks of gouty arthritis are seldom associated with residual disability.
acute attacks may lead to progressive cartilage and bone erosion due to
formation of tophi (depositions of
white ‘chalk-like?material), followed by secondary degenerative changes.
functional impairment and gross joint deformities may occur in chronic
are also frequently found in the cartilage of the ear, bursae and tendon
3. Urate urolithiasis
occurs in about 20% of patients with gout.
symptoms and signs associated with urolithiasis may appear.
Diagnosis: < BACK TO TOP >
presentation is usually very suggestive of gout.
serum urate level is usually raised
but does not prove the diagnosis because asymptomatic hyperuricaemia is very
fluid should be aspirated and examined under special microscope with
polarising light when needle-shaped
crystals of monosodium urate could be seen.
Joint radiographs can be useful in later stages of the disease when characteristic erosions may become apparent.
Management < BACK TO TOP >
dramatic response in acute gout follows within 24 hours of colchicine
[Colchicine, Colgout] that is given orally or sometimes intravenously.
are also effective in relief of pain and inflammation, corticosteroids may be
used in short courses to suppress severe inflammation.
which lower the serum urate level are considered in:
recurrent attacks of gouty arthritis
tophi or evidence of chronic gouty arthritis
associated renal disease (urolithiasis)
gout and markedly raised serum urate
[Capurate, Progout, Zyloprim, Allorin] is the hypouricaemic drug of choice; it
lowers the serum urate by inhibiting enzyme xanthine oxidase which is
responsible for the conversion of xanthine and hypoxanthine to uric acid; DNA
breakdown is then diverted towards other more soluble waste products that can
be more readily excreted.
is no need for severe dietary restrictions but excessive purine intake in meat
and overindulgence in alcohol should be avoided.
surgery for gross joint deformities associated with reduced movements is
Urolithiasis has to be appropriately treated (lithotripsy may be used).
Prognosis < BACK TO TOP >
Nutrition < BACK TO TOP >
Nutrition that alleviate or prevent gout :-
Cherry (or Cherry juice)
Herbs < BACK TO TOP >
Herbs that alleviate or prevent gout :-
Dr Zoran Pletikosa)
15 May 2009
19 June 2005
International Day of Families
Happy Father's Day
Animation Source : Minibyte Solutions
speaker Mr NgThian Watt the Principal Trainer from
Napoleon Hill Associates MalaysiaDetails