Gout is a metabolic disorder characterized by increased uric acid (hyperuricemia) leading to deposition of monosodium urate (MSU) crystals in the joints, causing painful inflammation.
Mnemonic: "G.O.U.T. =
Great Overproduction of Uric acid Triggers pain"
CAUSES & RISK FACTORS OF GOUT
- Primary Gout (Idiopathic – Genetic Defect in Uric Acid Metabolism).
- Secondary Gout (Due to Diseases or Drugs).
- Renal Failure → Decreased Uric Acid Excretion.
- Myeloproliferative Disorders (Leukemia, Polycythemia).
- Alcohol (Beer & Spirits Contain Purines).
- Drugs (Thiazide Diuretics, Low-Dose Aspirin, Cyclosporine).
Mnemonic: "R.A.D. = Renal
Failure, Alcohol, Drugs"
SYMPTOMS OF GOUT
- Acute Gouty Arthritis (Sudden, Severe Joint Pain, Redness, Swelling).
- Commonly Affects the First Metatarsophalangeal Joint (Podagra).
- Pain Peaks in 12-24 Hours & Resolves in 5-14 Days.
- Tophi Formation (Chronic Gout – Hard Uric Acid Deposits Under Skin).
- Kidney Involvement (Uric Acid Stones & Nephropathy).
Mnemonic: "P.T.K."
(Pain, Tophi, Kidney Stones)
STAGES OF GOUT
- Asymptomatic Hyperuricemia → No Symptoms, Only High Uric Acid.
- Acute Gouty Arthritis → Sudden, Severe Pain & Swelling in a Single Joint.
- Intercritical Period → No Symptoms Between Attacks.
- Chronic Tophaceous Gout → Multiple Attacks, Joint Damage, Tophi.
Mnemonic: "A.A.I.C."
(Asymptomatic, Acute, Intercritical, Chronic)
DIFFERENTIAL DIAGNOSIS OF GOUT
- Pseudogout (CPPD Crystals, Affects Knee, Shows Calcium Crystals on X-ray).
- Septic Arthritis (Fever, Pus in Joint Aspiration, Bacterial Culture Positive).
- Rheumatoid Arthritis (Symmetrical Joint Pain, Autoimmune Markers Positive).
- Cellulitis (Superficial Skin Infection, No Joint Involvement).
Mnemonic: "P.S.R.C."
(Pseudogout, Septic Arthritis, RA, Cellulitis)
DIAGNOSIS OF GOUT
- Synovial Fluid Analysis (Gold Standard – Needle-Shaped MSU Crystals, Negatively Birefringent).
- Serum Uric Acid Level (>7 mg/dL in Men, >6 mg/dL in Women).
- X-ray (Punched-Out Erosions & "Rat Bite" Lesions in Chronic Gout).
- Ultrasound (Double Contour Sign – Uric Acid Deposits on Cartilage).
Mnemonic: "S.U.X.U."
(Synovial Fluid, Uric Acid, X-ray, Ultrasound)
TREATMENT OF GOUT
1. ACUTE ATTACK MANAGEMENT
- NSAIDs (Indomethacin, Naproxen – First-Line for Pain & Inflammation).
- Colchicine (Blocks Neutrophils, Used if NSAIDs Are Contraindicated).
- Steroids (Prednisolone – For Severe Attacks or If NSAIDs & Colchicine Fail).
Mnemonic: "N.C.S."
(NSAIDs, Colchicine, Steroids)
2. LONG-TERM MANAGEMENT (To
Prevent Attacks & Lower Uric Acid)
- Allopurinol (Xanthine Oxidase Inhibitor – Lowers Uric Acid Production).
- Febuxostat (Alternative to Allopurinol, Safer in Kidney Disease).
- Probenecid (Uricosuric – Increases Uric Acid Excretion, Avoid in Kidney Stones).
Mnemonic: "A.F.P."
(Allopurinol, Febuxostat, Probenecid)
3. LIFESTYLE CHANGES
- Avoid Purine-Rich Foods (Red Meat, Shellfish, Organ Meats).
- Reduce Alcohol Intake (Especially Beer & Spirits).
- Drink Plenty of Water (Prevents Kidney Stones).
- Weight Loss (Reduces Uric Acid Levels).
Mnemonic: "P.A.W.W."
(Purines, Alcohol, Water, Weight Loss)
HOMOEOPATHIC MANAGEMENT OF GOUT
- For Acute Gouty Pain & Swelling:
- Colchicum, Ledum Pal, Bryonia, Benzoic Acid.
- For Chronic Gout & Tophi Formation:
- Lycopodium, Urtica Urens, Calcarea Fluor, Silicea.
- For Kidney Stones Due to Uric Acid:
- Berberis Vulgaris, Sarsaparilla, Cantharis.
Mnemonic: "C.L.U.B."
(Colchicum, Ledum, Urtica Urens, Berberis for Gout & Kidney Stones)
FINAL REVISION WITH MNEMONICS
- Definition = "G.O.U.T. = Great Overproduction of Uric acid Triggers pain"
- Causes = "R.A.D." (Renal Failure, Alcohol, Drugs)
- Symptoms = "P.T.K." (Pain, Tophi, Kidney Stones)
- Stages = "A.A.I.C." (Asymptomatic, Acute, Intercritical, Chronic)
- Differential = "P.S.R.C." (Pseudogout, Septic Arthritis, RA, Cellulitis)
- Diagnosis = "S.U.X.U." (Synovial Fluid, Uric Acid, X-ray, Ultrasound)
- Acute Treatment = "N.C.S." (NSAIDs, Colchicine, Steroids)
- Long-Term Treatment = "A.F.P." (Allopurinol, Febuxostat, Probenecid)
- Lifestyle = "P.A.W.W." (Purines, Alcohol, Water, Weight Loss)
- Homeopathy = "C.L.U.B." (Colchicum, Ledum, Urtica Urens, Berberis for Gout & Kidney Stones)
