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Gout

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Introduction to gout.
Epidemiology of gout.
Pathology of gout.
Risk factor for gout.

Publié dans : Santé & Médecine
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Gout

  1. 1.   Define  Discuss the epidemiology  Identify the age groups and gender differences  Explain the pathology and pathogenesis LEARNING OUTCOMES Izatty Lim (0308188) 2
  2. 2.   Derived from the latin word gutta, meaning "a drop" (of liquid).  Gout  A rheumatic disease resulting from deposition of uric acid crystals (monosodium urate) in the joints or soft tissues,  caused by elevated level of serum uric acid (hyperuricemia).  Hyperuricemia  serum uric acid concentration > 7 mg per dL (420 μmol per L),  caused by an imbalance in the production and excretion of urate DEFINE GOUT Izatty Lim (0308188) 3
  3. 3.   Gout has a worldwide distribution. The prevalence varies widely from country to country. Regional differences may reflect environmental, dietary, and genetic influences. EPIDEMIOLOGY  The predominant age range  30-60 years.  Men:  uric acid levels rise at puberty  peak age of onset  4th to 6th decade of life.  Women:  uric acid levels rise at menopause  peak age of onset  6th to 8th decade of life.  Male predominance  Estimated prevalence  5.9% in men and 2% in women.  Estrogenic hormones have a mild uricosuric effect gout unusual in premenopausal women Earlier onset of gout occurs in patients with renal insufficiency or a genetic abnormality of purine metabolism (eg, hypoxanthine-guanine phosphoribosyltransferase deficiency or phosphoribosylpyrophosphate synthetase superactivity). Cyclosporine A can cause an accelerated form of gout, even in premenopausal women, that can present after only a few years of hyperuricemia, particularly if the patient is also receiving diuretics. Izatty Lim (0308188) 4
  4. 4.   The prevalence of gout is higher in developed countries and in Oceanic populations compared with other areas of the world despite no data being available for a large part of the developing world. Global epidemiology of gout: prevalence, incidence and risk factors •Chang-Fu Kuo, •Matthew J. Grainge, •Weiya Zhang •& Michael Doherty Nature Reviews Rheumatology 11, 649–662 (2015) doi:10.1038/nrrheum.2015.91 Izatty Lim (0308188) 5
  5. 5.  AGE GROUP & GENDER DIFFERENCES Izatty Lim (0308188) 6
  6. 6.   Idiopathic  Major determinant  Hyperuricemia  Hyperuricemia  ↑ production uric acid  ↓ excretion uric acid PATHOGENESIS Izatty Lim (0308188) 7
  7. 7.  Hyperuricemia PATHOGENESIS  ↑ PRODUCTION URIC ACID  Increased purine synthesis de novo due to: - HGPRT reduction - hosphoribosyl-pyrophosphate synthase overactivity - Glucose-6-phosphatase deficiency with glycogen storage disease type 1  ↓ EXCRETION URIC ACID  Chronic renal disease  Drug therapy  Hypertension  Lead toxicity  Primary hyperthyroidism  Hypothyroidism  Glucose-6-phosphatase deficiency  ↑ TURNOVER OF PURINES  Myeloproliferative disorder  Lymphoproliferative disorder  Others; carcinoma Izatty Lim (0308188) 9
  8. 8.  Image taken from : Robbins Basic Pathology, 9th ed. Izatty Lim (0308188) 10
  9. 9. Raised serum urate Increase risk of gout Genetics Mutations in genes for urate transporter URAT1 & fructose transporter GLUT9 Age 2% of 45-64y/o men 6% men >75y/o have gout Gender Men:women ratio is 3:1 respectively Osteoarthritis Gout attacks more likely in joints affected by OA RA is protective Diet & alcohol Hypertension RISK FACTOR Izatty Lim (0308188) 12
  10. 10.  Thank You! Izatty Lim (0308188) 13

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