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Gouty Arthritis Adam Roscoe Sam Thomas Year 3 Medical Imaging Unitec

Gouty Arthritis Adam Roscoe Sam Thomas Year 3 Medical Imaging Unitec. Overview. Definition of Gout Pathological classification History of Gout Gout Aetiology & Pathogenesis Clinical management of Gout patients. Definition. Gout is a type of arthritis

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Gouty Arthritis Adam Roscoe Sam Thomas Year 3 Medical Imaging Unitec

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  1. Gouty ArthritisAdam RoscoeSam ThomasYear 3 Medical Imaging Unitec

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

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

  4. Pathological Classification • An inherited metabolic disease • Acute of Chronic

  5. 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

  6. History of Gout http://kimba63.files.wordpress.com/2011/02/egyptianpyramidsart21.jpg http://personal.georgiasouthern.edu/~rdanie12/hippocrates.jpg http://www.iep.utm.edu/wp-content/media/galen-200x220.jpg

  7. Gout topography • More likely to suffer Gout • Most often affects • Less likely to suffer Gout

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

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

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

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

  12. Pathogenesis • Excess uric acid levels decrease solubility • This leads to crystalization • Urate 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

  13. Gout management • Treatment 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

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

  15. Clinical tests: Patient history Focus will be on • Family history • Recent trauma • Patient’s lifestyle & diet

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

  17. Clinical tests: Blood/Urine • Performed to assess uric acid levels when Gout diagnosis is unclear

  18. Clinical tests: Xray • Performed mainly in later stages of Gout

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

  20. Case study

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

  22. References: 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 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 Gout: Exams and Tests. (2010). Retrieved from http://arthritis.webmd.com/tc/gout-exams-and-tests Kowalczyk, N., Mace, J. (2009). Radiographic Pathology for Technologists (5th 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 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

  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 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

  24. Acknowledgments of Support • Rouse Educational Trust • Pauline Hext

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