GoutGoutGouty ArthritisGouty Arthritis

By Mike ParenteauBy Mike Parenteau

Etiology/PathophysiologyEtiology/Pathophysiology

• Gout is a metabolic disease resulting from an accumulation of uric acid in the blood

• It is an acute inflammatory condition associated with infective metabolism of purines.

• Gout can be primary , secondary, or idiopathic.

• It affects men aproximately times more than women

PurinePurineA side noteA side note

• Purine is an organic compound commonly found in the body and is metabolized by the body into uric acid. People with primary gout have either an increased production of uric acid or an impaired excretion of uric acid, or a combination of both.

Etiology/PathophysiologyEtiology/Pathophysiology

• In this condition sodium urate crystals are deposited on the articular cartilage of joints and in the particular tissue like tendons. This provokes an inflammatory reaction of these tissues. These deposits often increase in size and burst through the skin to form sinuses discharging a chalky white material.

Etiology/PathophysiologyEtiology/Pathophysiology

• Normally, the human bloodstream only carries small amounts of uric acid. However, if the blood has an elevated concentration of uric acid, uric acid crystals are deposited in the cartilage and tissue surrounding joints. Elevated blood levels of uric acid can also result in uric kidney stones.

Etiology/PathophysiologyEtiology/Pathophysiology

• Of all people with gout, 85% have a genetic tendency to develop the disease.

• Tophi (uric acid crystal deposits ) result in inflammation of the joint; it is unclear why this occurs.

• Typically the big toes are involved, but other joints can be affected

Clinical ManifestationsClinical Manifestations

• Onset occurs at night, with excruciating pain, edema, and inflammation in the affected joint.

• The pain may be of short duration, or may be saver and continuous for 5 to 10 days.

• The patient may have repeated attacks or only one attack in a life time.

• Tophi are seen around the rim of the ear and can disfigure the ear. Surgical removal may be needed

Assessment/ SubjectiveAssessment/ Subjective

• Noting a complaint of pain occurring at night involving the big toe.

• Dietary history, with specific questions regarding alcohol and foods high in purine such as organ meats

   MMMM PIG Organs Its what's for dinner                      

                       

Assessment/SubjectiveAssessment/Subjective

• Assessment of joints for signs of edema, heat, discoloration, and limited movement

• Vital sign data may reveal an elevated temperature and hypertension, tachycardia, and tachypnea

• Tophi can form in the kidneys causing impaired function.

Diagnostic tests.Diagnostic tests.

• Serum and urinary uricacid levels

• C.B.C.• Elevated E.S.R.(Erthrocyte sedimentation rate)

• X- Ray revel cysts and toe bone pockets.

• Synovial fluid will contain urate crystals

Medical managementMedical management

• Acutely, first line treatment should be pain relief. Once the diagnosis has been confirmed, the drugs of choice are indomethacin, other nonsteroidal anti-inflammatory drugs (NSAIDs), or intra-articular glucocorticoids, administered via a joint injection.

Medical managementMedical management

• Colchicine was previously the drug of choice in acute attacks of gout. It impairs the motility of granulocytes and can prevent the inflammatory phenomena that initiate an attack of gout. Colchicine should be taken within the first 12 hours of the attack and usually relieves the pain within 48 hours. Its main side-effects (gastrointestinal upset) can complicate its use. NSAIDs are the preferred form of analgesia for patients with gout.

Nursing IntervetionsNursing Intervetions

• Interventions are aimed at giving medications prescribed by the physician for relief of pain and inflammation

• When giving colochicine it is important to observe for side effects, such as diarrhea, nausea, and vomiting.

• Increase fluid intake

• Careful documantation of I and O.

Nursing IntervetionsNursing Intervetions

• Bed rest

• Joint immobilization

• Pt teaching is aimed at giving info about the disease and stressing the importance of keeping uric acid levels within normal limits