gout
GOUT
Gout is a condition that resulted from deposition of monosodium urate crystals in various tissues (eg joints, connective tissue, kidney).
The patient experiences acute and chronic arthritis, soft tissue inflammation, tophus formation, gouty nephropathy and nephrolithiasis.
Primary hyperuricemia is called when uric acid saturation arises without coexisting diseases or drugs that alter uric acid production and excretion.
While in secondary hyperuricemia there is an excessive uric acid production or diminished renal clearance that occurs as a result of a disease, drug, dietary product or toxin.

Definition

  • Gout is a condition wherein there is increased uric acid or urate in the body, also called hyperuricemia, that leads to deposition of monosodium urate monohydrate crystals in various tissues (eg joints, connective tissue, kidney)

Pathophysiology

  • Hyperuricemia is a necessary precondition for the development of monosodium urate monohydrate crystal deposition but this has to be distinguished from gout, the clinical syndrome
  • Results in acute & chronic inflammation associated with changes in articular & periarticular structures

Epidemiology

  • Affects up to 1-2% of adults & is the most common inflammatory arthritis in men
  • Prevalence of gout in the Asia-Pacific region varies
    • Ethnic groups in China & Malaysia (eg Malays, Tamils) were found to have higher uric levels as compared to the Japanese & Thai
    • Taiwan is one of the countries in the world with highest prevalence of gout

Risk Factors

Risk factors for gout & associated comorbidity should be assessed

Risk factors associated with gout:

  • Hyperuricemia
    • Single most important risk factor for developing gout
  • Male sex
  • Menopausal women
  • Age
  • Purine-rich diet (eg meat, seafood)
  • Alcohol intake
  • Diuretic use
  • Other drug use (eg low-dose Aspirin, antihypertensive medications, Ciclosporin)
  • Lead exposure

Metabolic abnormalities associated with gout:

  • Hypertension
  • Obesity
  • Dyslipidemia
  • Hyperglycemia & insulin resistance

Comorbidities associated with gout:

  • Coronary artery disease
  • Type 2 diabetes mellitus
  • Renal insufficiency
  • Metabolic syndrome
  • Kidney stone
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