Gout

Gout ( podagra ) is the most common cause of inflammatory arthritis worldwide characterized by a raised uric acid level in the blood and deposition of urate crystals in joints and other tissues.

Background-Purines→ cyclical organic molecules Disorder of purine metabolism ↑ uric acid level in blood When plasma saturated with UA , UA crystals are liable to form( usually > 0.415 mmol/ L or 6.8 mg / dL ) in joints & other tissues as connective tissues or the urinary tract Gout may present without hyperuricaemia and hyperuricaemia may occur without gout Clinical manifestation of gout may include♦ Tophi ♦ Chronic arthritis ♦ Urolithiasis ♦ Renal disease ♦ Recurrent acute arthritis ♦ Bursitis ♦ Cellulitis

Excessive uric acid formation -Dietary → High purine dietAlcohol excess Endogenous overproduction- several complex mechanisms may cause this Obesity Paget's dis Haemolysis Myeloproliferative disorder Polycythemia vera Severe psoriasis Tissue necrosis Solid tumours

Reduced uric acid excretion-Excretion of UA is almost entirely by the kidney Reduced GFR ( any reason ) Hypertension Acidosis ( Ketoacidosis , Lactic acidosis ) Starvation Polycystic kidney dis Hypothyroidism Hyperparathyroidism Diabetes insipidus Lead nephropathy Drugs ( aspirin , cyclosporine , L dopa , diuretics, ethambutol , pyrazinamide , nicotinic acid...