2.  Gout is characterized by elevated uric acid concentrations in blood and urine due to variety of metabolic abnormalities that include overproduction of purine nucleotides or the decreased excretion of uric acid

3.  Increased PRPP Synthetase activity  Decrease in HGPRTase activity  Glucose -6-phosphatase deficiency  Elevation of glutathione reductase  Lack of feedback control of PRPP glutamylamido transferase

4. Fructose Adiposity Insulin resistance Hypertension Overconsumption of alcohol Defect in renal transport of urate

5.  asymptomatic hyperuricemia: Of those with hyperuricaemia, 20% will go on to develop acute symptomatic gout.  acute gouty arthritis: the first attack involves one joint but it can also be polyarticular. Without specific treatment, an attack of acute gout is likely to resolve within 7–10 days.  interval or intercritical gout: If the urate level remains high (>0.36 mmol/L) despite the patient being symptom free, there can be ongoing joint inflammation and hence joint damage and tophi formation.

6.  chronic or tophaceous gout: tophi are firm white translucent nodules due to deposition of urate crystals. It can take at least 10 years after the initial attack to develop. As well as causing joint destruction, they are disfiguring and also cause physical hindrance. Tophi can become inflamed or infected and can exude tophaceous material.

7.  severe, sudden pain in one or more joints  (most often the joint in the big toe)  swollen joint(s)  red or purplish, tight, shiny skin over joint  Chills  Renal lithiasis  Uric acid nephropathy  Urate nephropathy  general feeling of illness  rapid heartbeat  hard lumps of urate crystal deposits under the skin (called tophi)

8.  Gout may be confirmed with the examination of a fluid sample from the joint for the presence of urate crystals.  A tophus proved to contain urate crystals by chemical means or polarized light microscopy Needle shaped MSU crystals identified within the joint. Viewed under polarizing light with a red compensator.

9.  X-ray – Acute Soft tissue swelling – Chronic chronic tophaceous gouty arthritis, extensive bony erosions are noted throughout the carpal bones Sclerosis and joint-space narrowing are seen in the first metatarsophalangeal joint, as well as in the fourth interphalangeal joint.

10. Allopurinol decreases both uric acid formation and de novo synthesis of purine nucleotides Colchicine- antiinflamatory drug, other antiinflamatory drugs such as phenylbutazone, indomethacin, oxyphenbutazone,corticosteroids also useful. Uricosuric drugs- enhance renal excretion of uric acid Restriction in dietry intake of purines and alcohol Vietnamese traditional medicine indicate that 96 plants, including chrysanthemum sinense have been used to treat gout.

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