yogabook / pathologie / gout

gout

Gout

Definition of

Blood uric acid level > 7 mg (sometimes also 7.5). There are 4 stages, deposits that have already formed remain, the symptoms described below are those of stage 2. The stages in detail:

1. asymptomatic hyperuricemia
2. Acute attack of gout (usually after 20-40 years stage 1). At 8 mg/dl 25% of patients suffer an attack, at 9 mg/dl almost everyone
3. Interurticarial stage with further progressive joint damage
4. Chronic gout with irreversible joint destruction, tophi, kidney disease, frequent attacks, possibly without a pain-free interval, the attacks then become less severe.

ICD M10

Cause

1. 3 groups of causes:
2. primary: congenital: an enzyme for purine metabolism is missing, resulting in reduced excretion by the kidneys
3. secondary, increased endogenous purine accumulation:
4. Leukemias, tumor decay, radiation, cytostatic administration, fasting, large organ necrosis, polycythaemia vera, chronic myeloproliferative neoplasia, chronic granulocytic leukemia, multiple myeloma (Kahler’s disease), sickle cell anemia
5. secondary, exogenous causes:
6. secondary, other causes:

Predisposing

1. BMI from 25 + increased consumption of meat or seafood. (Consumption of dairy products reduces the risk!)

Diagnosis

1. Blood: BSG, CRP, leukocytosis, elevated serum uric acid
2. Urine: elevated uric acid
3. Urate crystals in the synovia(synovial fluid)
4. Small, sharply defined osteolyses
5. Leukocytosis

Symptoms

1. out of full health, usually at night, extremely painful monarthritis urica, 80% in one leg, 60% of which is the metatarsophalangeal joint (podagra). Secondarily also the metatarsophalangeal joint of the thumb (chiraga), or ankle or rarely also the knee. The attack usually occurs at night and usually after a rich meal and alcohol, sometimes also triggered by infection or great exertion. If untreated, the attack lasts several days
2. General signs of inflammation: swelling, redness, overheating, pain is so great that any touch, even through clothing, is disturbing
3. Signs of inflammation and extreme sensitivity to touch in the affected joint
4. possibly fever, headache, palpitations, nausea
5. Pruritus of the skin over the affected joint, the skin peels
6. Duration: a few d, up to max. 3 weeks, spontaneous subsiding
7. In addition: Gouty gout (urate deposits), especially on the auricle (helix), archilles tendon; possibly urate nephrolithiasis (not visible on X-ray, therefore contrast X-ray)
8. In stage 4, the monarthritis turns into polyarthritis with significant pain and restricted movement

Complications

1. Nephritis due to deposits of urate crystals in the kidney
2. Kidney stones (urate stones)
3. Renal insufficiency

Therapy

1. Therapy: in acute attacks; cryotherapy (cold chamber)
2. appropriate medication in the genetic case
3. Colchicine (poison of the autumn crocus)
4. Alcohol cessation
5. Low purine diet
6. Drink a lot
7. Possibly diuretics
8. NSAIDs such as ibuprofen or diclofenac. ASA is contraindicated!
9. Cortisone