gouty arthritis is a common disease that affects the joints of the feet, especially the thumb. It is a purine metabolism disorder that runs in families.
Purine is a type of protein found in liver, kidney, meat extracts, sardines, etc. and a disruption of its metabolism leads to an abnormal accumulation of uric acid (a product of purine metabolism) in blood.
Uric acid is deposited later hated around the joints. Gout is a treatable forms of arthritis can be managed with diet and good care. If left untreated, it can become chronic and spread of the big toe and other joints.
Impact
gouty arthritis is more common in men, especially after the age of 40-50.
Predisposing Factors
i. Heredity: 20% of patients with this disease have a family history of gout
ii. Sex: It is more common in men than in women
iii. Age: 40 years after the start
IV. Infection
c. Obesity
vi. Alcohol abuse
vii. Hypertension
viii. Minor Surgery
ix. Irritation
Pathophysiology
The patient is unable to metabolize purine for unknown reasons. This leads to an excessive accumulation of uric acid in blood. For reasons unknown to uric acid, instead of being removed from the system through urine, blood accumulates in excess. This leads to the formation of crystals of uric acid (urate), and these crystals are deposited in the joints and form lumps called Toph (tartaric).
Toph stimulates the inflammatory response and irritation, which leads to swelling and pain. Toph can be deposited in the kidneys and form kidney stones, leading to permanent changes are harmful to the kidneys. Toph can be deposited on the skin, cartilage and pinna.
Types of Gout
1. Acute Gout: It could be precipitated by surgery, a minor infection or irritation caused by tight shoes. It may present with pain in affected joints, headache, malaise and tachycardia. These symptoms may go by itself without treatment, but returned later.
2. Chronic Gout: It came from repeated attacks of acute gout untreated or inadequately treated. It takes a period of approximately 10 years before the first attack of chronic gout to develop. Joints can degenerate and lose its ability to move over time. Toph can be found around joints and cartilage of the ears.
Diagnosis
A.Microscopic study of synovial fluid revealed the presence of uric acid crystals (Toph and ugly)
b.Erythrocyte ESR (ESR) and white cells are both increased during acute crises. The normal value ESR (Wintergreen) is 2-5mm/hr for men, women and children 4-7mm/hr, while white blood cells (WBC) was 4000-10000 per cm3
c.Uric acid plasma level is also higher (hyperuricemia), following the discount rate is excreted in urine. The normal value is 5mg/100ml blood.
Treatment
Medication management of gouty arthritis is the same as for other forms of arthritis. However, the following drugs are used together:
1. Probenecid (Benemid): It works by promoting tubular excretion of uric acid crystals. 0.5-1 g / day was given in divided doses. The liquid should rise to about 3,000 ml per day while on this medicine. Probenecid side effects include allergic dermatitis, anorexia, constipation, and hematuria. Medication management should be under supervision of doctors and nurses.
2. Allopurinol (Zyloprim): It works by inhibiting the formation of uric acid. 100 per day dose is 300 mg. Some side effects are urticaria, rash, hypersensitivity, anemia, bone marrow depression, cataracts, peripheral neuritis, abdominal pain, diarrhea, etc.
Diet
rich in purines, such as kidneys, liver, heart, fatty fish, brain food, should be suspended for some time.
Nursing not for others arthritis must be respected.
Surgery
Surgery may be used to remove Topham.
Complications of gouty arthritis
i. Progressive renal failure
ii. Deformation
iii. Cerebral thrombosis
IV. Coronary Thrombosis
c. Arteriosclerosis
vi. Hypertension.
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