Gout is a chronic inflammatory disease that affects nearly 4% of the population in the United States (Tophi and frequent gout flares). In fact, it is the most common form of crystal-induced arthropathy, and the most common inflammatory arthopathy in men older than 40 years (Bolognia, First Consult). Gout is a deposition disease of metabolic origin caused by supersaturation of monosodium urate, or hyperuricemia. Needle-like crystals are deposited into joints, connective tissue, and the kidneys. This deposition may lead to various clinical sequelae such as arthritis, tophi, and acute kidney injury (Bolognia). Gout can transition through many phases including asymptomatic, acute, and chronic disease (3). Environmental or genetic causes contribute
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Secondary forms of gout are related to excessive cell turnover or secondary renal impairment (Tophi as first manifestion of gout). Increased turnover may be related to diets rich in purines including proteins, fats, and sugary foods like soft drinks (Tophaceous gout in finger pads). Under-excretion of uric acid by the kidneys accounts for up to 90% of gout cases (Tophi as first mani). Heavy alcohol intake and medications including diuretics, aspirin, and nicotinic acid may decrease excretion of uric acid and contribute to an acute attack (Tophaceous gout in the finger pads). Gout is also associated with hypertension, obesity, dyslipidemia, diabetes mellitus and insulin resistance (Multiple asymptomatic nodules in middle-aged (Rheum book chap 188). Rare causes of hyperuricemia include tumor lysis syndrome, genetic conditions such as Lesch Nyhan syndrome, or malnutrition (Tophaceous gout in the finger …show more content…
Dietary changes such as eliminating purine rich foods and substituting for carbohydrate-rich and fatty foods may be difficult in patients with comordities such as diabetes and hyperlipidemia (Tophi as first manifestation of gout). Medical treatment of chronic tophaceous gout includes long-term use of uric-acid lowering drugs such as allopurinol or probenecid (Tophaceous gout in the finger pads). Comorbities such as renal disease, hypertension, and diabetes must be considered before initiating medical treatment (Tophaceous gout in the finger pads). Prior to the introduction of these gout medications approximately 60 years ago, chronic tophaneous gout would affect approximately half of patients with history of gout. However, this incidence has decreased significantly following the advent of allopurinol and colchicine (Rheum chap 188). It is critical to reinforce to patients the importance of long-term management of gout, as complications of long-standing untreated gout may include secondary infection, urate nephropathy, renal stones, nerve impingement, or fractures in joints with tophi
Secondary forms of gout are related to excessive cell turnover or secondary renal impairment (Tophi as first manifestion of gout). Increased turnover may be related to diets rich in purines including proteins, fats, and sugary foods like soft drinks (Tophaceous gout in finger pads). Under-excretion of uric acid by the kidneys accounts for up to 90% of gout cases (Tophi as first mani). Heavy alcohol intake and medications including diuretics, aspirin, and nicotinic acid may decrease excretion of uric acid and contribute to an acute attack (Tophaceous gout in the finger pads). Gout is also associated with hypertension, obesity, dyslipidemia, diabetes mellitus and insulin resistance (Multiple asymptomatic nodules in middle-aged (Rheum book chap 188). Rare causes of hyperuricemia include tumor lysis syndrome, genetic conditions such as Lesch Nyhan syndrome, or malnutrition (Tophaceous gout in the finger …show more content…
Dietary changes such as eliminating purine rich foods and substituting for carbohydrate-rich and fatty foods may be difficult in patients with comordities such as diabetes and hyperlipidemia (Tophi as first manifestation of gout). Medical treatment of chronic tophaceous gout includes long-term use of uric-acid lowering drugs such as allopurinol or probenecid (Tophaceous gout in the finger pads). Comorbities such as renal disease, hypertension, and diabetes must be considered before initiating medical treatment (Tophaceous gout in the finger pads). Prior to the introduction of these gout medications approximately 60 years ago, chronic tophaneous gout would affect approximately half of patients with history of gout. However, this incidence has decreased significantly following the advent of allopurinol and colchicine (Rheum chap 188). It is critical to reinforce to patients the importance of long-term management of gout, as complications of long-standing untreated gout may include secondary infection, urate nephropathy, renal stones, nerve impingement, or fractures in joints with tophi