Rajesh Bhalla

Gout The culprit

"GOUT" ....😒. is that what troubling you there?....

Compassion is in the Heart of Our thought

GOUT … is that what paining me !

  Well this what most of the time is the hidden disease which even dodge the good clinical skill . This is a form of crystal arthropathy and characterized by a swollen, redness of the joints  along with  its severe painful movements.

  The reason for all these is FLUCTUTATING level of the uric acid in the blood which later precipitate as crystals in the joints this cause the inflammation.

Presentation of this condition :- Sudden Attack of
  • Redness around the joint or the foci.
  • Painful swelling or painful joint (classically at great toe Joint ). The severity may fluctuate on and off with certain food habits particularly night binge (alcohol). Even while sleeping in the night.
  • Hot /warm skin.
Different presentation in different age group


How the URIC acid is created and where it goes
Pathophysiological changes of the Uric acid in the joint
Etiology- Foods and drinking habits that often trigger gout attacks includes meat, some types of fishes, fruit juice, sugary sodas, high protein diet  and alcohol. This  could be metabolic err also (Excessive production/poor Show by Kidney)
Tophi ,collection of the uric acid crystal underneath soft tissues
  • Weight. More the weight more the protein metabolism, more the load and frequent chocking of kidney 
  • Medical conditions.  untreated high blood pressure and chronic conditions such as diabetes, obesity, metabolic syndrome, and heart and kidney diseases, cancer.
Clinical picture of gout, swelling of soft tissue mean ligaments edema and the skin along with boggy synovial membrane,  means sheath lining the joint) .
  • Certain medications. Low-dose aspirin and some anti hypertensive drugs — including thiazide diuretics, angiotensin-converting enzyme (ACE) inhibitors and beta blockers causes hyperuricemia.
  • Hereditary gout. If your other family members also  had gout, you’re are more likely to develop the disease.
  • Age and sex. Gout occurs more often in men, primarily because women tend to have lower uric acid levels. After menopause, however, this difference stands equalizer  Men are also more likely to develop gout earlier — usually between the ages of 30 and 50 — whereas women generally develop signs and symptoms after menopause.
  • Recent surgery or trauma. Experiencing recent surgery or trauma can sometimes trigger a gout attack. In some people, a vaccination may trigger a gout attack.
  1.  Clinically – Recurrent episode or  acute case of swollen ,red and tender joint.
  2.  Serologically – Raised Inflammatory parameters i.e. Neutrophils, ESR ,CRP,URIC ACID >6mg/dl , hyperuricemia ( Normal plasma urate 2-6mg/dl).
  3. Microscopy  of the Joint’s fluid-  Your doctor may use a needle to draw fluid from your affected joint. 
  4. Ultrasound:- This test uses sound waves to detect urate crystals in joints or of tophi.
  5. Radiologically  – Erosion of joint and irregular joint coverage (the Cartilage erosion). Loss of morphology of the joint.
  6. Dual-energy computerized tomography (DECT):- This test combines X-ray images taken from many different angles to visualize urate crystals in joints.

Management:-  Two objectives   

  • First-To control the ongoing inflammation
  1. Cold compression, rest and stop all above triggering factors . Exercise lifestyle.
  2. Pain  killers- Indomethacin /Piroxicam are the best among the NSAID (Non Steroid Anti Inflammatory Drugs )for this work.
  3. Colchicine s the first line of drug, under medical supervision be started 1 mg with titration to .5mg next 2 to 3 hourly  if required to maximum 3 dose a day.
  4. Steroid i.e prednisolone is to control this acute attack.
  • Second-To prevent  future recurrent attacks.
  1. Medications that block uric acid production e.g. 




      2. Medications that improve uric acid removal/Excretion.


All have their side effects so no self medication please.



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