1. GOUT A metabolic disease in which tissue deposition of crystals of monosodium urate occurs from supersaturated extracellular fluids and results in one or more clinical manifestations. These include: 1: GOUTY ARTHRITIS Reccurent attacks of severe acute or chronic articular or periarticular inflammation 2: GOUT TOPHI accumulation of articular, osseous, soft tissue and cartilaginous crystalline deposits 3: GOUTY NEPHROPATHY renal impairment 4: URIC ACID CALCULI in the urinary tract

2. Gout-uric acid Uric acid is the breakdown product of the purine residues of nucleid acid Two-thirds is excreted via the kidney and the rest via the gut

3. Gout Primary gout Secondary gout -increase dietary intake of purines -overproduction e.g. Myelo- and lymphoproliferative disorders -decrease renal excretion in renal failure or tubular excretion

4. ACUTE GOUTY ARTHRITIS An acute attack of gout is a dramatic, very painful condition typically ache and inflammation in one big toe The joint is : swollen, red hot very painful The joint slowly returns to normal often with desquamation and peeling of the overlying skin

10. ACUTE GOUTY ARTHRITIS- treatment NSAIDs are useful during acute attacks Colchicine Intra-articular steroids

11. CHRONIC TOPHACEOUS GOUT Tophi-small chalky deposits appearing on the: ears hands around MTP joints olecranon bursae If the condition is still not treated Gross knobbly swelling develop and may: ulcerate become secondarily infected cause severe restriction of movement