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GOUT
ARTICULAR CRYSTAL DEPOSITION IS ASSOCIATED WITH
MONOSODIUM URATE-GOUT
CALCIUM PYROPHOSPHATE
BASIC CALCIUM PHOSPHATE
“DISEASE OF KINGS”
EPIDEMIOLOGY OF GOUT
USUALLY ADULT MEN
5% FEMALE-RARE IN CHILDREN AND AN WOMAN
DURING REPRODUCTVE YRS
POSITIVE CORELATION-PROTEIN INTAKE ,MEAN
WT,ALCOHOL CONSUMPTION,SOCIAL
CLASS,INTELLIGNCE
GOUT
CLASSIFICATION OF GOUT
Primary gout(90%)
Diet
unknown Enzyme defect
Known enzyme defect(HGPRT)
Reduced excretion of uric acid
Gout classi……
SECONDARY GOUT(10%)
A) OVER PRODUCTION LESS EXCRETION
(LEUKEMIA AND AGGRESSIVE
NEOPLASM)
B) INBORN ERROR OF METABOLISM(HGPRT)
C) REDUCED EXCRETION-CHR RENAL FAILURE
PATHOGENESIS
OF GOUT
Purine metabolism
I ) de novo pathway
II) Salvage pathway
HYPERURICEMIA
Renal transport system
GFR
Reabsorption
Secretion
Post secretory reabsorption
Hypoxanthine guanine
phospho ribosyl transferase
(HGPRT)
CONTRIBUTING FACTOR FOR GOUT
Age > 20-30
Genetic predoposition-X linked multifactorial runs
in family
Heavy alcohol
Obesity
Drugs-thiazine
Lead toxicity
PATHOGENESIS……
...
ACUTE ARTHRITIS
2
...
TOPHI AT MULTI SITES
4
...
ASYMTOMATIC HYPERRICEMIA
2
...
INTERCRITICAL GOUT
4
...
TUBERCULAR ARTHRITIS
HAEMATOGENOUS SPREAD
SECONDARY TO PULMONARY TUBERCULOSIS