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GOUT

GOUT. Why so angry?. “Dino-sores”. Quiz. Metabolic Syndrome X does not include: High Cholesterol (HLD) High Blood Pressure (HTN) High Fat (Obesity) High Sugar (DM) Super Hero Powers. Quiz. Metabolic Syndrome X does not include: High Cholesterol (HLD) High Blood Pressure (HTN)

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GOUT

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  1. GOUT

  2. Why so angry?

  3. “Dino-sores”

  4. Quiz • Metabolic Syndrome X does not include: • High Cholesterol (HLD) • High Blood Pressure (HTN) • High Fat (Obesity) • High Sugar (DM) • Super Hero Powers

  5. Quiz • Metabolic Syndrome X does not include: • High Cholesterol (HLD) • High Blood Pressure (HTN) • High Fat (Obesity) • High Sugar (DM) • Super Hero Powers

  6. Synovial Joint Anatomy • Synovial fluid – raw egg white • Tendon – bone to muscle • Ligament – bone to bone

  7. Synovial Joint

  8. Synovial Joint Physiology • Movement • Clean • Cartilage

  9. Diet • Exercise • Genetics Uric Acid

  10. Monosodium Urate Crystals (MSU) • Uric acid > 6.8 • Temperature

  11. Tophus • Crystals • Surrounded by Immune cells, epithelial cells, fibroblasts

  12. Tophus • crystals surrounded by inflammatory reaction

  13. Gout

  14. 1. Asymptomatic Hyperuricemia • Blood Concentration > 6.8 • Sometimes leads to Gout

  15. 2. Acute Gouty Arthritis • First Metatarsal phalangeal (MTP) joint • Macrophage response • “Inflammation”

  16. Morphology • Dense neutrophilic infiltrate permeating the synovium and synovial fluid. • Long, slender needle-shaped monosodium urate crystals are frequently found in the cytoplasm of the neutrophils as well as in small clusters in the synovium. • The synovium is edematous and congested, and contains scattered mononuclear inflammatory cells. • When the episode of crystallization abates and the crystals solubilize, the attack remits.

  17. 3. Intercritical Period • Complete remission • Medication, diet, exercise • Second attack within a couple years

  18. 4. Chronic Tophaceous Gouty Arthritis • Joint Damage • Tophus Formation • 10 years later

  19. Morphology • Evolves from repetitive precipitation of urate crystals during acute attacks. • The urates can heavily encrust the articular surfaces and form visible deposits in the synovium. • The synovium becomes hyperplastic, fibrotic, and thickened by inflammatory cells, forming a pannus that destroys the underlying cartilage, and leading to juxtaarticular bone erosions. • In severe cases fibrous or bony ankylosis ensues, resulting in loss of joint function.

  20. Synovial Changes

  21. Kidneys

  22. Review

  23. Who does not?

  24. Who does not?

  25. Summary • Asymptomatic • Acute Attack • Intercritical Period • Chronic Tophaceous Gout

  26. Movies to watch • Gout in blood https://www.youtube.com/watch?v=ymhmqoRR_y8 • Gout in knee joint https://www.youtube.com/watch?v=vuoBE5uE9y8

  27. Bonus

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