Goyt

It due to accumulation urate

of crystals the
°

in in

synovial fluid resulting in

inflammation leading to
acute arthritis .

acid lowered to
At 30°C
solubility in 4.5
my 1dL
°

, g uric

thus uric acid in

deposited in cooler areas like distal
joints .

metabolic
°
The main
gout
abnormality with in increased cellular

pool D PRPP
[ Phosphor ibosyl pyrophosphate ] .

°
Increased excretion
g
Uni acid Calculi / stone formation with

types
Renal
damage .

Two ca '
Primary gout
.

(b)
Secondary gout
Primary Gout :

° About 10%
of cases
of primary gout an
idiopathic .

°
Incidence =
l : 500 in total
population -

Cue :

(a) 5-
phosphor ibosyl Amid o
Transferase :

The abnormal is Active but not sensitive to feed back

enzyme
-

regulation by inhibitory nucleotides .

This will lead to production of nucleotides

-

over
purine .

(b) Abnormal PR PP synthetase :

-
This
enzyme found
is to have a
higher Iman which leads to
increased production of PRPP .

(c)
Deficiency of Enzymes of Solvay Pathway :

nucleotides
Reactions which consume PRPP and produce more will

inhibit the enzyme , eq . Salvage Pathway .

 (
di Glucose - G -

phosphatase Deficiency :

Gierke 's disease [ Glycogen

ydejse.gg
- This condition is called storage
Due to
deficiency this
glucose
-

& is
enzyme
more more
g ,

channeled into Pentose -

phosphate shunt pathway mulling

in more
availability of Ribose
phosphate This leads to
- 5- . PR PPA

Secondary Goyt :

°
It be due to enhanced turnover rate Nucleic acids as seen
may g
in :

( as
Rapidly growing malignant tissues .

due to
(
b,
Hyper uricemia in cancer
patients inc . cellular
turnover
co Increased tissue damage due to trauma and raised rate g

catabolism as in starvation .

Reduced Excretion Rate :

( is Renal failure

( iii Treatment with thiazide diuretics which inhibit tubular secretion

of uric acid .

ciii , Lactic acidosis & keto acidosis due to

interference with tubular
-

secretion .

Location of Gout
Attack :

Gouty attacks
may be precipitated by high
diet and intake
purine increased
g
alcohol .

. The typical gouty Arthritis affects the first

metatarsi
phalangeal joints , others
may
also be
affected .

Total urate fool [ Normal increased to

omg ]
• -
- ko in
 [ 3000mg ] in
gout patients without top hi and [ 30,000mg] in

patients with tophi! joints causing

swelling )
Diagnosis :

By X
Rays
° -

examination
synovial fluid
.

° Blood tests ( Plasma urate

level 420
goes to
I, Tmo 4L
( Hyper uricemia)

Differential diagnosis
°
.

Treatment :

( is Reduce
dietary purine intake .

and restrict alcohol

( ii , Increase renal excretion

of urate
by Uni cosmic drugs ( probe new 'd )

( iii , Reduce urate production

by Allopurinol .

Colchicine
civs Anti
Inflammatory
-
-

( to arrest the arthritis in

gout )
( vs NSAIDs and Corticosteroids

are also anti -

inflammatory .
② Med Notes ( med notes .
in )
-