Purine synthesis

Body purine nucleotides

Purines

Uric acid Tissue nucleic acids

Intestinal excretion

Renal excretion

Uric Acid Synthesis and Elimination

Dietary purine

ETYMOLOGY

Term Definition

Gout Derived from the Latin word gutta which means “a drop”

Gouty arthritis refers to a form of arthritis caused by deposits of needle-like crystals of uric acid.

Pseudogout deposits are made up of calcium phosphate crystals, not uric acid.

Purines are protein components in foods that are found commonly in Dark fillet fish (mackerel, anchovies, sardines, herring and fish roe), Peanuts, Alcohol, Dairy products (milk, ice cream, cottage cheese)

Abarticular referring to gout that occurs in structures other than joints

Podagra gout of the great toe joint.

Uric acid the chemical metabolite of purines.

Anton van Leeuwenhoek described the microscopic appearance of uric acid crystals in 1679. Spiked rods of uric

acid (MSU) crystals photographed under a microscope with polarized light from a synovial fluid sample.

The Tyrannosaurus rex specimen known as "Sue" appears to have suffered from gout.

Colchicum was brought to America by Benjamin Franklin; Franklin suffered from gout himself and had written humorous doggerel about the disease during his stint as Envoy to France.

Gout is accurately diagnosed through the identification of characteristic crystals.

Uric acid results from the breakdown of purines. Purines are part of all human tissue and found in many foods

In humans, the upper end of the normal range is 360 µmol/L (6 mg/dL) for women and 400 µmol/L (6.8 mg/dL) for men.

Stages of Gouty ArthritisStages of Gouty Arthritis

CausesCauses

Risk FactorsRisk Factors

ETiology

Classifications of Gouty ArthritisClassifications of Gouty Arthritis

ETiology

M:F = 20:1 Overproduction of uric acid Abnormality of renal urate excretion

Overconsumption of purine-rich foods

Heredity

Use of diuretics

alcohol consumption

ETiology

PATHO

of

Gout

Underexcretion of uric acid

Overproductionof uric acid

Crystals in the synovial fluid Podagra

Hyperuricemia

Kidney stones

Chemotactic factors, lysosomal enzymes, PGE2, LTB 4, IL1&6

Formation MSU crystal

Responding cellsNeutrophils, leukocytes, monocytes, fibroblast,

synoviocytes, renal cells

Tissue damage

Inflammation

Manifestations

• Sudden onset of severe pain in great toe or occasionally the heel, elbow, ankle, wrist and fingers

• >Hot, red and tender joints• >Intense, intolerable pain• >Chills, fever

Nursing Diagnosis

1.Acute pain r/t stimulations of free nerve endings 2 to urate crystals deposits in joints

2.Activity intolerance r/t acute attack of inflamed joints

3. Disturbed body image r/t joint deformity.

Diagnosis

Synovial fluid analysis

Blood test

Differential

Serum analysis

• elevated serum urate levels• > 800 mg/dl

white blood cell count

• elevated• >recurrent attacks of acute

inflammatory arthritis• >accumulation of urate crystals in

the form of tophaceous deposits• >uric acid nephrolithiasis• >Martel's Sign or 'rat bite sign‘