Gout arthritis

During my second year study in New Zealamd College of Chinese Medinine(NZCCM), we start to learn western medicine as an auxillary tool to help us make more understandable dignosis in practice. The project we learned this year is pathology which is a precise study of making specific diagnosis of diseases. Pathology addresses 4 components of disease: cause/etiology, mechanisms of development (pathogenesis), structural alterations of cells (morphologic changes), and the consequences of changes (clinical manifestations).

Today I will take gout aithritis as an example to explain how the disease affects our body.Gout results from deposits of uric acid and urate crystals in the joint that then cause an acute inflammatory response. More than 99% of primary gout cases are referred to as idiopathic, meaning that the cause cannot be determined. However, doctors believe that gout is most likely the result of a combination of hormonal, genetic, and dietary factors. Secondary gout may be caused by drug therapy or by medical conditions other than an inborn metabolic disorder.
Gout is 9 times more common in men than women. Gout often affects men in their 40’s and 50’s although gout attacks can occur after puberty. Gout attacks are more common in women after menopause. Gout attacks are also more common in people with kidney disease. The following factors increase your risk for gout:
• advancing age
• drinking a large amount of alcohol, particularly beer
• eating purine-rich foods
• exposure to lead
• family history of the condition
• male gender
• obesity
• other, serious illness
• organ transplants
• thyroid problems
• use of certain drugs, including diuretics, aspirin, cyclosporine, or levodopa
A sudden increase in serum uric acid levels usually precipitates an attack of gout. Gout often affects a single joint, such as in the great toe. When acute inflammation develops from uric acid deposits, the articular cartilage is damaged. The inflammation causes redness and swelling of the joint and severe pain. Attacks occur intermittently. A tophus is a large, hard nodule consisting of urate crystals that have been precipitated in soft tissue or bone, causing a local inflammatory reaction. Tophi usually occur a few years after the first attack of gout and may develop at joint bursae, on the extensor surfaces of the forearm, or on the pinnae of the ear.

If the gout arthritis left untreated, it may lead to erosions, deformity and disability due to chronic inflammation-causing secondary joint degeneration. It can also cause hypertension and albuminuria and chronic renal failure due to accumulation of urate crystals and destruction of kidney tubules.

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