Gout Presentation Group 2

Valentine Mhute
Kingston Gwekwe
Tadiwa Chidavaenzi
Tadiwa Maimba
Linda Chipango
Moyo Vitalis
Harder Dorcas
Definition
• Gout refers to a metabolic disorder characterized
by increased deposition of urate crystals in the
joints and connective tissue (tophi) and results in
episodic acute or chronic arthritis.
• Is also a common form of inflammatory arthritis
that is very painful. It usually affects one joint at a
time (often the big toe joint).
• There are times when symptoms get worse, known
as flares, and times when there are no symptoms,
known as remission.
• It also leads to deposition of urate crystals within
the renal interstitium or nephrolithiasis.
• Signs and Symptoms • Risk Factors
• Swelling in joints, • Being male (more common in men than women)
• Overweight
• Pain, usually intense
• Family history
• Redness • Medications, e.g. diuretics
• Fever • Excessive consumption of alcoholic beverages such
as beer.
• Poor mobility
• Eating or drinking food and drinks high in fructose
• Tenderness • Diet: Having a diet high in purines, which are
• Flulike symptoms metabolised into uric acid. Purine-rich foods include
red meat, organ meat, and some kinds of seafood,
• Tenderness such as shellfish and tuna.
• Health conditions including: diabetes mellitus,
congestive heart failure (CHF), renal insufficiency
(poor kidney function)
Metabolic pathway of Uric Acid production
Metabolic pathways of uric acid formation from nucleotide monophosphates. AMP, adenosine monophosphate; IMP,
inosine monophosphate; XMP, xanthine monophosphate, GMP, guanine monophosphate.
Pathophysiology
• Uric acid is end product of purine metabolism and is
excreted by the kidneys
• Hyperuricemia results from:
-Increase in uric acid production
-Underexcretion of uric acid by kidneys
• Both: diet high in purines will not cause gout, but may trigger
an attack in a susceptible person
Management of Gout
• Acute Gout • Chronic Gout
-Colchicine • Collaborative Care Prevention of acute
-NSAIDS (Indomethacin, attacks:
Diclofenac, Naproxen, Etoricoxib) • Urate Lowering Drugs
• Allopurinol
• Corticosteroids (Prednisolone)
• Febuxostat
• Probenecid
• Sulfinpyrazone
Management Continued
• Colchicine
MOA:  Reduce lactic acid production by leukocytes, which in turn decreases uric acid deposition and reduces
phagocytosis, with abatement of the inflammatory response.
• Uses: Terminating acute attack, 0.6-1.2mg, then 0.6mg every 2-3hrs.
• Adverse effects: diarrhoea, abdominal pain

• NSAIDs examples include Indomethacin, Diclofenac, Naproxen

• M.O.A: Inhibit the cyclooxygenase (COX) enzymes, which are involved in the inflammatory process and
prostaglandin production.
• Indomethacin taken 50mg every 6hrs, reduced to 25mg 6-8 hourly. Indomethacin is better tolerated than
Colchicine.
• Aspirin is contraindicated in gouty arthritis treatment.

• Corticosteroids are recommended for monotherapy,

• These agents are generally reserved for patients who cannot tolerate either colchicine or NSAIDs due to their
systemic adverse effects.
• Examples: Prednisolone
Continued..
• Treatment of Chronic gout
• Allopurinol and Febuxostat.
MOA: Xanthine oxidase inhibitors. Inhibits synthesis of uric acid.
Reverse deposition of urate crystals in joints and block formation of
renal stones.
• Use: long acting given 100mg once daily, up-to 300mg/d, to reduce uric
acid levels.
• Is used in chronic tophaceous gout and gout nephropathy.
• Febuxostat is more effective in lowering uric acid levels for treatment of
chronic gout.
Continued..
Uricosuric agents
• Useful in under secretors of Uric Acid
• Probenicid: not analgesic or anti-inflammatory. Acts by promoting excretion of uric acid by
inhibiting its active reabsorption renal tubules.
• Use in chronic gout, given with plenty of water and urinary alkaliser to prevent form of urate
stone
• Dosage: 500mg/d

• Adverse effects: allergic dermatitis, convulsions in toxic dose, nephrotic syndrome

• Sulfinpyrazone: structurally related to phenylbutazone. In therapeutic doses, prevents

reabsorption of uric acid from renal tubules.
• Dosage: 100-200mg/d orally, increasing over 2 weeks to 600mg/d.
The End
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