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Disease ARTHRITIS-GOUT
   
Quotation “Gout, which rusts aristrocratic hinger”
   
Definition A clinical disorder with poly-arthritis with poly-arthritis caused by hyperuricaemia leading to deposition of monosodium urate crystals in tissues.
   
Prognosis Total control is possible with early treatment. If recurrent attacks occur, life long uricosurics or allopurinol prevents attacks. During the first 6-24 months of such therapy, attacks of gout might occur. Asymptomatic hyper-uricaemia does not need therapy. There is No significant correlation between gout and CAD. Renal involvement with urate deposition can occur but is of slow progression with No effect on life expectancy.
   
General Measures Ensure high liquid intake.Restriction of high purine foods like meat extract, kidney, liver, anchovied, sardines, sweet breads would appear to play significant role.Cautious use of alcoholic beverages.Avoid use of Thiazides, Loop diuretics, Small dose aspirin, and nicotinic acid, as they block uric acid excertion leading to hyperuricaemia.
   
Advice to Patient Drink 2.5 litres of water daily.Do not take uricosuric drug an acute attack.Do not take aspirin when on uricosurics. Avoid large alcool itake, and diuretics.
   
Follow Up If on uricosurics monitor, CB, renal and hepatic function and urine analysis at monthly intercals until desired levels of uric acid are obtained.
   
Inadequate Response If acute attacks keep recurring, consider possibility of uricosurics causing and try NSAIDs in low doses.Or possibly related to inadequate fall in Uric acid levels, May try (Sulfinpyrazone 400mg/daily or ACTH)
   
Prevention High fluid intake/ cautious use of alcohol.Colchine prophylaxis-for patients with mild hyperuricaemia and recurrent attacks (0.5 mgs bid).Use of Uricosurics, Allopurinol used as indicated above.Colchicine may be used to prevent an attack precipitated by starting Uricosurics/ Allopurinol.
   
Reference From www.pajournal.com/pajournal/cme/pa911a.html
   

 

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