### Date : 2024-06-16 09:17 ### Topic : Gout(통풍) #medicine #rheumatology ---- ### Gout Overview **Gout** is a form of inflammatory arthritis characterized by sudden, severe attacks of pain, redness, and tenderness in joints. It is caused by the ==accumulation of urate crystals== within the joint, leading to inflammation and intense pain. ### Pathophysiology ==Gout occurs when there is an excess of uric acid in the blood (hyperuricemia)==. Uric acid is a byproduct of the breakdown of purines, substances found in certain foods and drinks. When uric acid levels become too high, they can form sharp, needle-like crystals in joints or surrounding tissues, causing pain and inflammation. ### Clinical Features - **Acute Gout Attack:** Sudden onset of intense joint pain, often at night. The affected joint is typically red, swollen, and extremely tender. ==The big toe (metatarsophalangeal joint) is most commonly affected==, but other joints can be involved, such as ankles, knees, wrists, and fingers.  <Photo from: https://www.ultrasound-guided-injections.co.uk/wp-content/uploads/2020/03/gout-01.jpg> - **Tophi:** Chronic gout can lead to the formation of tophi, which are deposits of urate crystals that can form lumps under the skin around joints or in other tissues like the ears.  <Photo from: https://medlineplus.gov/ency/images/ency/fullsize/19833.jpg> - **Kidney Stones:** High uric acid levels can also lead to the formation of uric acid kidney stones. ### Diagnosis Diagnosis is based on clinical presentation and confirmed through: - **Joint Fluid Analysis:** Aspiration of the affected joint fluid and examination under a microscope for urate crystals. - **Blood Tests:** Elevated serum uric acid levels (though not all patients with high uric acid levels will develop gout). - **Imaging:** X-rays or ultrasound can be used to detect joint damage or tophi. ### Example Case Study **Patient Profile:** - **Name:** Dr. Jee Hoon Ju - **Age:** 55 - **Gender:** Male - **Occupation:** Construction Worker **Medical History:** - **Symptoms:** Jee Hoon Ju reports waking up suddenly at night with severe pain in his right big toe. The toe is red, swollen, and extremely tender to touch. He has experienced similar episodes in the past year, but this is the most severe. - **Diet and Lifestyle:** High consumption of red meat, seafood, and alcohol. He also has a history of high blood pressure. **Physical Examination:** - **Joint:** The right metatarsophalangeal joint is swollen, red, and warm to the touch. Jee Hoon Ju winces in pain even with light pressure on the joint. **Laboratory Tests:** - **Joint Fluid Analysis:** Presence of urate crystals. - **Blood Tests:** Elevated serum uric acid levels (8.9 mg/dL). (Normal: 4.0 - 8.5 mg/dL) **Diagnosis:** Based on Jee Hoon Ju’s symptoms, physical examination, and laboratory test results, he is diagnosed with gout. ### Management 1. **Acute Gout Attack Treatment:** - **NSAIDs:** Indomethacin or naproxen to reduce pain and inflammation. - [[Why Indomethacin or Naproxen are commonly preferred NSAIDs for treating acute gout attacks?]] - **Colchicine:** To decrease inflammation. - **Corticosteroids:** For patients who cannot take NSAIDs or colchicine. 2. **Long-term Management:** - **Lifestyle Changes:** Dietary modifications to avoid purine-rich foods (red meat, seafood), reducing alcohol intake, and maintaining a healthy weight. - **Urate-lowering Therapy:** Allopurinol or febuxostat to reduce uric acid production. - **Probenecid:** Increases uric acid excretion. 3. **Monitoring and Follow-Up:** - Regular monitoring of serum uric acid levels. - Periodic assessment of joint function and kidney health. ### Conclusion Gout is a manageable condition with appropriate treatment and lifestyle modifications. Early diagnosis and intervention are crucial to prevent chronic complications and improve the quality of life for patients like John. Regular follow-up and patient education on lifestyle changes are key components of effective management.