This is the case of a patient with Gouty arthritis. Numerous  | The Medical Herald

This is the case of a patient with Gouty arthritis.

Numerous large tophi with associated joint deformity are clearly appreciated in both hands of this patient.

•Gout is a form of inflammatory arthritis characterized by recurrent attacks of a red, tender, hot, and swollen joints, where crystals in the form of monosodium urate form inside and around joints (called tophi).

•The most known hallmark of the disease is hyperuricemia, but by itself it does not indicate gout. Hyperuricemia means an increased production of uric acid due either a defect or hyperactivity in an enzyme, HGPRT (Hypoxanthine Guanine Phosphoribosyl Transferase) and increased cell turnover (or cell breakdown) in patients that use chemotherapy for cancer, have chronic hemolysis, or have hematologic malignancies.

•Another even more common reason for gout is decreased excretion of uric acid by the kidneys due to renal disease and NSAID or diuretics usage.

•Inflammation typically develops when uric acid collect in the synovial fluid as the extracellular fluid becomes saturated with the acid which is then phagocytized by polymorphonuclear cells. This process develops inflammation.

•Pain typically comes on rapidly in less than 12 hours.

•The joint at the base of the big toe is affected in about half of cases. It may also result in kidney stones, or urate nephropathy.

•Severe gout is characterised by frequent polyarticular flares, numerous tophi, joint damage, and musculoskeletal disability.
This is a preventable condition and in many cases, represents a disease that has been insufficiently managed for years.

TREATMENT:
Standard management recommendations may be insufficient for patients with severe gout. Such patients frequently require intensive individualised pharmacological management with combinations of Urate-lowering therapy, Steroids, Colchicine and Anti-inflammatory agents.

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