gout causes and symptoms
- [voiceover] so gout is a joint disease that actually doesn't havemuch to do with the joint in the sense that the joint is fine. but it's a deposition of something that doesn't belong in the joint that causes all our problems. i'm drawing it on the big toe here because that's where goutis most commonly located. and it's been described as oneof the worst kinds of pain.
an acute gout inflammation,this person probably can't walk, and their big toe willbe swollen like this. the culprit here, the little crystals are called monosodium urate. monosodium urate. and it's a crystallized form of uric acid, which is something thatis normally in our body as a byproduct, a breakdown product of our dna and rna.
but when for some reasonthere's too much of this, it crystallizes and as itgoes throughout our body, it gets stuck in this joint. and whatever joint it's stuck in is gonna be painful and cause gout. but more often than not it's here. and by the way, gout inthe big toe is so common it actually has its ownname called podegra. podegra.
the group of people thatmost often get gout, if we're trying to look at statistics, it's gonna be males andusually a little older, on the older side. so i will say 50 plus. some people say it hasto do with lifestyle. and one of the treatments forgout is lifestyle changes. they're on a path of physiology level. anything that increases uric acid
is likely to lead to the symptoms of gout. so in terms of symptoms,we have a lot of pain. especially in an acute flare. and if we look at it, it will look red, which we call erythema. it's red and swollen. any way that we think ofit as a joint disease, this metatarsal joint, but the deposition is actually also
in the surrounding tissues as well. and this intense inflammation here will also cause the areato feel hot to the touch. so the symptoms and the history should give a lot ofgood clues for diagnosis. but to formally diagnose it, we have a gold standard test. we can take some of the fluid in the joint space and analyze it.
and the diagnostic of goutis to find these needles. when we look at it under polarized light, they're gonna be negatively birefringent. birefringent. so that's a lot physicsthat i don't understand. but i know that what they meanby a negative birefringence is that if they're laying flat, the needles aren't laying flat. it's gonna be a yellow color.
and this will be helpful later on when we talk about distinguishinggout from pseudogout. these particular needles madeof monosodium urate will, as a rule, when laid flat withthe polarized light on it, it's gonna look yellow. so that's the synovial joint fluid. but we can also take some blood. and in people who have chronic gout or even just more likely to get gout,
we might, we'll probablysee hyperuricemia. uricemia, which is gonnalead to more uric acid. this is a direct evaluation of uric acid. it can not only tell us this person has or is likely to get gout, but as we treat them,we can use this to track how effective the treatment is. we can also get a white blood cell count and a erythrocyte sedimentation rate,
which is measuring how fast the red blood cells become sediment. but these are really inflammation markers. this one is a marker of inflammation, and this one is a marker of howactive our immune system is. so both of these can actually go up even without an infection. white blood cell we think ofas a marker for an infection. even though this is not an infection
because these crystals are not bacteria, they're not pathogen, but the immune system it elicits, can make these numbers go up as well. so even though the history can be very characteristic of gout, we want to do thesetests to distinguish it from other things it could be, like infectious arthritisor the auto-immune things
that you really don't want to miss, because the treatment forgout can be very specific. first, there's gonna be thenon-specific treatments. we want to deal with the pain, so nsaids, which also will actuallydecrease the inflammation. so nsaids and possibly stronger things, if they cannot tolerate nsaidsor if the pain is too great. and then we want todecrease the inflammation. these are not specific.
you can use these in a lotof auto-immune type diseases. and in here we can use steroid injections, among other things. but in gout, actually, thefirst thing they should do is to have a lifestyle change. there is a genetic component to gout, but there's also a lifestyle component. it is actually hard to separate the genetic from the lifestyle.
but thinking of the uric acid, we want to help them do things that decrease the uric acid to begin with. so eating less meat, not drinking alcohol, organic things to help themproduce less uric acid. and on top of that we can usedrugs to do the same thing, decrease the uric acid. and these can be taken during a flare.
but also perhaps more importantly, we can take them as prophylaxis. so even if the patient is nothaving symptoms at the moment, or they just have a history of gout, we can give them a steady, long-term dose. and the prophylaxis hasto do with the pathway that leads to the production of uric acid. and we can slow these down to chemically decreaseuric acid in the blood.
but of course, lifestyleis still very important. and we shouldn't just rely on the drugs. so patients really need good counseling, in addition to having the drugs that just treat the symptoms. and lastly, we want totalk about pseudogout. it's named because it looksvery much like a gout, but it is not because of the deposition of the crystals in the joint.
so first of all, insteadof being in the big toe, we actually think of gout as more likely to happen in the knee. so instead of being in the toe, we have all the same symptoms in the knee. you have the pain, theredness, the swelling, the temperature, that'swhy it looks like gout. but the thing that's deposited is actually completely different.
instead of monosodium urate, we have calcium pyrophosphate. let's see if i can fitthis whole word here. pyrophosphate dihydrate. dihydrate. but most people probablyjust wanna use the acronym, and that's why you'llprobably see it as cppd. so it has nothing to do, soit's a very different pathway, different deposition of crystals.
and for the diagnosis, we actually go through the same systemto distinguish the two. and instead of needles, when we look at this fluidunder the same light, there are gonna berhomboid shaped crystals instead of a thin needle. and it's gonna be weaklypositive birefringence. so this is the whole reasonthat we care about it because they birefringence tells us
whether it's pseudogout or gout and also the shape of the crystals. and treatment also willactually follow the same themes. so we treat the symptoms, the pain, and the anti-inflammatorythings are the same. and by the way, steroids, instead of taking oralsteroids for both of these, you can inject into the joint space right to where the pain is.
may provide faster andmore stronger relief. but since in the pseudogout we're not dealing with uric acid, the prophylaxis hereobviously doesn't apply. pseudogout is somewhatless common than gout. and so for the purpose of having the correct specific treatment and also for following thedisease in the long run, we really want to distinguishbetween gout and pseudogout
before we proceed with drugslike the uric acid prophylaxis.