2. Definition of Gout Definition of Gout Pathological classification Pathological classification History of Gout History of Gout Gout Aetiology & Pathogenesis Gout Aetiology & Pathogenesis Clinical management of Gout patients Clinical management of Gout patients

3. Gout is a type of arthritis Gout is a type of arthritis Gout results from an inflammatory response to build up of Uric acid in blood Gout results from an inflammatory response to build up of Uric acid in blood Progresses to Urate crystals in joints Progresses to Urate crystals in joints Urate crystals erode articulating surfaces of bone Urate crystals erode articulating surfaces of bone

4. An inherited metabolic disease An inherited metabolic disease Acute of Chronic Acute of Chronic Acute Sudden Onset Short term symptoms Can resolve without treatment Can progress to chronic Gout Chronic Recurring problem Insufficient resolution between attacks Cartilage/bone destruction results

5. Acute Gout Acute Gout http://www.gout-attack.com/wp- content/uploads/2011/02/Gout-toe- attack.jpg http://www.gout-attack.com/wp- content/uploads/2011/02/Gout-toe- attack.jpg

6. 129-200 AD Galen described Tophi. Galen recognised hereditary nature of Gout 460-370 BC Hippocrates described Gout as an acute inflammation of 1 st MTP joint Discovered in 2640 BC by Egyptians http://personal.georgiasouthern.ed u/~rdanie12/hippocrates.jpg http://www.iep.utm.ed u/wp- content/media/galen- 200x220.jpg http://kimba63.files.wordpress.co m/2011/02/egyptianpyramidsart21.jpg

7. More likely to suffer Gout More likely to suffer Gout Most often affects Most often affects

8. Gout appears as radiolucent bone erosions around joints Gout appears as radiolucent bone erosions around joints Soft tissue swelling and inflammation present Soft tissue swelling and inflammation present http://www.bpac.org.nz/magazine/2007/september/images/gout_ xray_bpac.jpg

9. http://www.learningradiology.com/archives06/COW%20227- Gout-elbow/goutelbowcorrect.html

10. Gout results from a build up of Uric acid Gout results from a build up of Uric acid Uric acid results from metabolism of Purines Uric acid results from metabolism of Purines High blood uric acid levels can be due to a Purine-rich diet or kidney insufficiency High blood uric acid levels can be due to a Purine-rich diet or kidney insufficiency

11. The nephron The nephron Higher incidence of Gout in males as Oestrogen assists renal clearance of uric acid Higher incidence of Gout in males as Oestrogen assists renal clearance of uric acid

12. Excess uric acid levels decrease solubility Excess uric acid levels decrease solubility This leads to crystalization This leads to crystalization Urate deposits are covered with proteins as part of immune response forming Tophi Urate deposits are covered with proteins as part of immune response forming Tophi Tophi are the cause of bone erosion Tophi are the cause of bone erosion http://www.hopkinsarthritis.org/wp- content/uploads/2011/04/gout_fig7.gif

13. Treatment is in two stages Treatment is in two stages  Minimization of the acute inflammation  Prevention of future attacks Acute attacks are managed with drugs. They last 1-2 weeksAcute attacks are managed with drugs. They last 1-2 weeks Chronic conditions are treated by lowering uric acid levels through exercise, weight loss, diet changesChronic conditions are treated by lowering uric acid levels through exercise, weight loss, diet changes

14. Patient history & physical examination Patient history & physical examination Arthrocentesis test Arthrocentesis test Blood/Urine analysis Blood/Urine analysis X-ray studies X-ray studies

15. Focus will be on  Family history  Recent trauma  Patient’s lifestyle & diet

16. Test involves aspirating synovial fluid from affected joint Test involves aspirating synovial fluid from affected joint Fluid is examined for urate crystals Fluid is examined for urate crystals Performed when diagnosing chronic Gout Performed when diagnosing chronic Gout

17. Performed to assess uric acid levels when Gout diagnosis is unclear Performed to assess uric acid levels when Gout diagnosis is unclear

18. Performed mainly in later stages of Gout Performed mainly in later stages of Gout

19. Patient had pain, swelling, deformities of 1 st MTP joints. Patient had pain, swelling, deformities of 1 st MTP joints. Swelling around 3 rd MCP joint in both hands Swelling around 3 rd MCP joint in both hands

21. MRT contact with Gout patients is usually in later stages of disease MRT contact with Gout patients is usually in later stages of disease Be mindful positioning as the patient may be in pain Be mindful positioning as the patient may be in pain

22. Anton, F., Garcia, J., Ramos, T., Gonzalez, P., Ordas, J. (1986). Sex Differences in Uric Acid Metabolism in Adults. Metabolism: Clinical and Experimetal, 35(4), 343-8. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/3959904 http://www.ncbi.nlm.nih.gov/pubmed/3959904 Dalbeth, N. (2006). The Pathway from Gout to Bone Erosion. Retrieved from http://www.hrc.govt.nz/sites/default/files/HRC69%20(Dalbeth).pdf http://www.hrc.govt.nz/sites/default/files/HRC69%20(Dalbeth).pdf Doherty, M. (2009). New Insights into the Epidemiology of Gout. Oxford Rheumatology Journal, 48:ii2–ii8. doi:10.1093 Eustice, C. (2012). Cut Back Purine-Rich Foods with Gout. Retrieved from http://arthritis.about.com/cs/goutdiet/a/goutpurines.htm http://arthritis.about.com/cs/goutdiet/a/goutpurines.htm Gout. (2012). Retrieved from http://www.healthinplainenglish.com/health/musculoskeletal/gout/index.htm http://www.healthinplainenglish.com/health/musculoskeletal/gout/index.htm Gout: Exams and Tests. (2010). Retrieved from http://arthritis.webmd.com/tc/gout-exams-and-tests http://arthritis.webmd.com/tc/gout-exams-and-tests Kowalczyk, N., Mace, J. (2009). Radiographic Pathology for Technologists (5 th ed.) St. Louis, Missouri: Mosby Elsevier Mandell, B. (2008). Clincal Manifestations of Hyperuricemia and Gout. Cleveland Clinical Journal of Medicine, 75(5). Retrieved from http://ccjm.org/content/75/Suppl_5/S5.full.pdf http://ccjm.org/content/75/Suppl_5/S5.full.pdf Manno, R. (2012). Clinical Features of Gout. Retrieved from http://www.hopkinsarthritis.org/arthritis-info/gout/clinical- presentation-of-gout/ http://www.hopkinsarthritis.org/arthritis-info/gout/clinical- presentation-of-gout/http://www.hopkinsarthritis.org/arthritis-info/gout/clinical- presentation-of-gout/ Marieb, E., Hoehn, K. (2007). Human Anatomy & Physiology (7 th ed.). San Francisco, CA: Pearson Benjamin Cummings

23. Nuki, G., Simkin, P., (2006). A Concise History of Gout and Hyperuricemia and their Treatment. Journal of Arthritis Research and Therapy 2006, 8(1), doi:10.1186/ar1906 Stoppler, M. (2012). Gout. Retrieved from http://www.medicinenet.com/gout/page2.htm http://www.medicinenet.com/gout/page2.htm Taylor, K. (2012). Uric Acid Crystals. Retrieved from http://www.goutpal.com/uric-acid/uric-acid-crystals/ http://www.goutpal.com/uric-acid/uric-acid-crystals/ Teitel, A. (2011). Gout. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001459/ http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001459/ Zare, F., Magnusson, M., Bregstrom, T., Brisslert, M., Josefsson, E., Karlsson, A., Tarkowski, A. (2006). Uric Acid, a nucleic acid degredation product, down-regulates dsRNA-triggered arthritis. Journal of Leukocyte Biology, 79(3), 482- 4. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16387838 http://www.ncbi.nlm.nih.gov/pubmed/16387838

24. Rouse Educational Trust Rouse Educational Trust Pauline Hext Pauline Hext