GOUT

GOUT
By:
Wayne Blount, MD, MPH
Professor, Emory Univ. S.O.M.

OBJECTIVES

* Identify diagnostic criteria for gout
* Identify 3 treatment goals for gout
* Name the agents used to treat the acute flares of gout and the chronic disease of gout


Why Worry About Gout ?
* Prevalence increasing
* May be signal for unrecognized comorbidities : ( Not to point of searching)
Obesity (Duh!)
Metabolic syndrome
DM
HTN
CV disease
Renal disease

URATE, HYPERURICEMIA & GOUT
* Urate: end product of purine metabolism
* Hyperuricemia: serum urate > urate solubility (> 6.8 mg/dl)
* Gout: deposition of monosodium urate crystals in tissues

HYPERURICEMIA & GOUT
* Hyperuricemia caused by
Overproduction
Underexcretion
* No Gout w/o crystal deposition
THE GOUT CASCADE
* Urate
* Oevrproduction Underexcretion
* Silent Gout Renal Associated
* Tissue manifestations CV events &
* Deposition mortality

GOUT: A Chronic Disease of 4 stages
* Asymptomatic hyperuricemia
* Acute Flares of crystallization
* Intervals between flares
* Advanced Gout & Complications

ACUTE GOUTY FLARES
SITES OF ACUTE FLARES
INTERVALS SANS FLARES
FLARE INTERVALS
ADVANCED GOUT
* Chronic Arthritis
* X-ray Changes
* Tophi Develop
* Acute Flares continue
* Chronic Arthritis
* Polyarticular acute flares with upper extremities more involved

TOPHI
TOPHI RISK FACTORS
RADIOLOGIC SIGNS
X-RAYS
DIAGNOSING GOUT
SERUM URATE LEVELS
GOUT RISK FACTORS
DIFFERENTIAL DIAGNOSIS
* Pseudogout: Chondrocalcinosis, CPPD
* Psoriatic Arthritis
* Osteoarthritis
* Rheumatoid arthritis
* Septic arthritis
* Cellulitis
Gout vs. CPPD
RA vs Gout
REDNECK MEDICAL TERMS
TREATMENT GOALS
ENDING ACUTE FLARES
Acute Flare Med Choices
MED Considerations
PROTECTION VS. FUTURE FLARES
PREVENT DISEASE PROGRESSION
URICOSURIC AGENTS
XANTHINE OXIDASE INHIBITOR
WHICH AGENT ?
NEW AGENTS
URICASE ENZYMES
CASE STUDIES
WHAT ARE J.F.’s RISK FACTORS FOR GOUT ?
HOW WOULD YOU DX GOUT ?
NEXT STEP FOR J.F. ?
IN WHAT STAGE OF GOUT IS M.B. ?
WOULD YOU CHANGE MD’S RX ?
WHAT OTHER ISSUES WOULD YOU CONSIDER ?
CONCLUSIONS

GOUT.ppt