BROOKLYN 3 STUDENTS Adam ROSCOE Samuel THOMAS
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Transcript of BROOKLYN 3 STUDENTS Adam ROSCOE Samuel THOMAS
BROOKLYN 3STUDENTS
Adam ROSCOE Samuel THOMAS
Fri 30th Aug 2013Session 2 / Talk 5
11:25 – 11:35
ABSTRACTA short presentation on Gouty arthritis, to help further our understanding of a common indication seen on Xray requests. In our presentation we are going to cover the basics of Gout, including a definition, pathological classification, history and nature of this joint pathology, and also clinical management of patients suffering from Gout.Gout is a type of arthritis that results from an inflammatory response to a build up of uric acid in the vascular system progressing to erosion of the articulating surfaces of bones. It is an inherited metabolic disease and is classed either as an acute or chronic condition. Gout is more prevalent in males and can be influenced by diet and lifestyle. The pathogenesis of Gout involves the metabolism of Purines, a type of nucleic acid found in beer, fish, and mushrooms. This results in a waste product called Uric acid, which if not regulated by the Kidney, will crystallize and lead to bone erosion. Clinicians suspecting Gouty arthritis in their patient are likely to consider the patient’s history, and send for tests such as Xray or synovial joint aspirations.
Gouty ArthritisAdam RoscoeSam Thomas
Year 3 Medical Imaging Unitec
OverviewDefinition of GoutPathological classificationHistory of GoutGout Aetiology & PathogenesisClinical management of Gout patients
DefinitionGout is a type of arthritisGout results from an inflammatory
response to build up of Uric acid in blood
Progresses to Urate crystals in jointsUrate crystals erode articulating
surfaces of bone
Pathological ClassificationAn inherited metabolic diseaseAcute of Chronic
Acute
Sudden Onset
Short term symptomsCan resolve without
treatmentCan progress to
chronic Gout
Chronic
Recurring problem
Insufficient resolution between attacks
Cartilage/bone destruction results
Pathological Classification
Acute Gout
http://www.gout-attack.com/wp-content/uploads/2011/02/Gout-toe-attack.jpg
Chronic Gout
http://www.bpac.org.nz/magazine/2007/september/gout.asp?page=2
History of Gout
129-200 AD Galen described Tophi. Galen recognised hereditary nature of Gout
460-370 BC Hippocrates described Gout as an acute inflammation of 1st MTP joint
Discovered in 2640 BC by Egyptians
http://personal.georgiasouthern.edu/~rdanie12/hippocrates.jpg
http://www.iep.utm.edu/wp-content/media/galen-200x220.jpg
http://kimba63.files.wordpress.com/2011/02/egyptianpyramidsart21.jpg
Gout topographyMore likely to
suffer Gout
Most often affects
Less likely to suffer Gout
Radiographic appearanceGout appears as radiolucent bone
erosions around jointsSoft tissue swelling and inflammation
present
http://www.bpac.org.nz/magazine/2007/september/images/gout_xray_bpac.jpg
Radiographic appearance
http://www.learningradiology.com/archives06/COW%20227-Gout-elbow/goutelbowcorrect.html
AetiologyGout results from a build up of Uric
acidUric acid results from metabolism of
Purines
High blood uric acid levels can be due to a Purine-rich diet or kidney insufficiency
AetiologyThe nephron
Higher incidence of Gout in males as Oestrogen assists renal clearance of uric acid
PathogenesisExcess uric acid levels
decrease solubilityThis leads to crystalizationUrate deposits are covered
with proteins as part of immune response forming Tophi
Tophi are the cause of bone erosion http://www.hopkinsarthritis.org/wp-content/uploads/2011
/04/gout_fig7.gif
Gout managementTreatment is in two stages
Minimization of the acute inflammation Prevention of future attacks
• Acute attacks are managed with drugs. They last 1-2 weeks
• Chronic conditions are treated by lowering uric acid levels through exercise, weight loss, diet changes
Clinical testsPatient history & physical examinationArthrocentesis testBlood/Urine analysisX-ray studies
Clinical tests: Patient historyFocus will be on Family history Recent trauma Patient’s lifestyle & diet
Clinical tests: ArthrocentesisTest involves aspirating synovial fluid
from affected jointFluid is examined for urate crystals
Performed when diagnosing chronic Gout
Clinical tests: Blood/UrinePerformed to assess uric acid levels
when Gout diagnosis is unclear
Clinical tests: XrayPerformed mainly in later stages of
Gout
Case studyPatient had pain, swelling, deformities
of 1st MTP joints.Swelling around 3rd MCP joint in both
hands
Case study
ConclusionMRT contact with Gout patients is
usually in later stages of diseaseBe mindful positioning as the patient
may be in pain
References:Anton, F., Garcia, J., Ramos, T., Gonzalez, P., Ordas, J. (1986). Sex Differences in Uric Acid Metabolism in
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Dalbeth, N. (2006). The Pathway from Gout to Bone Erosion. Retrieved from 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
Gout. (2012). Retrieved from http://www.healthinplainenglish.com/health/musculoskeletal/gout/index.htm
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Kowalczyk, N., Mace, J. (2009). Radiographic Pathology for Technologists (5th ed.) St. Louis, Missouri: Mosby Elsevier
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Manno, R. (2012). Clinical Features of Gout. Retrieved from http://www.hopkinsarthritis.org/arthritis-info/gout/clinical-presentation-of-gout/
Marieb, E., Hoehn, K. (2007). Human Anatomy & Physiology (7th ed.). San Francisco, CA: Pearson Benjamin Cummings
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
Taylor, K. (2012). Uric Acid Crystals. Retrieved from http://www.goutpal.com/uric-acid/uric-acid-crystals/
Teitel, A. (2011). Gout. Retrieved from 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
Acknowledgments of SupportRouse Educational Trust
Pauline Hext