Gouty arthritissss Pathophy

Gout Pathophysiology Pre"isposing factors (SECODARY *OU&) Here"ity Age Se$ Race+Et#nicity

Precipitating factors (PRIMARY CAUSE) Diet Obesity Starvation Heatopoietic Rena! Disor"er Hypertension A!co#o! Into$ication Pro!onge" %se of Di%retics Car"iovasc%!ar Disor"er Organ &ransp!ant 'ea" e$pos%re

P%rine synt#esis

Ce!!%!ar f%nction

,i"ney -%nction Acce!erate" rate of p%rine synt#esis into p%rine

-ree -i!tration of %rate (ser% %ric aci") at t#e g!oer%!%s

. t%rn over of n%c!eic

Over pro"%ction of %ric Acce!erate" rate of p%rine synt#esis into p%rine

Acce!erate" %rate

Over pro"%ction of Uric Aci"

Un"er e$cretion of %ric aci" Hyper%riceia

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SUA 0123

Pro"%ction of onoso"i% %rate -oration of onoso"i% %rate crysta!s in t#e synovia! f!%i"/ synovia! ebrane or Sti%!ation of inf!aatory

Moentary constriction of sa!!

. Capi!!ary pereabi!ity -!%i"

4aso"i!ation (Hypereic

----------------- R%bor / Ca!or . 56C -ever

Congestio Margination

Iigration

P#agocytosis of %rate

'o7 p%rine "iet/ . O-I to . %rinary o%tp%t

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&%or/ Do!or/ -%nctio!ae sa

SAIDS/ Co!c#icine/ an" ot#er inf!aatory "r%gs

Re!ease of !ysosoa! contents fro 'ysosoa! en8yes Urate crysta!s

6ioc#eica!s t#at attract ore ne%trop#i!s

6ioc#eica!s t#at trigger inf!aation

Contin%e" Inf!aation

Intercritica! stage

C#ronic

Macrop#age "ifferentiate into !arge epit#e!oi" ce!!s

M%!tin%c!eate" giant ce!!s

&O *ran%!oa -oration -------------PHI "ep osit s

Inf!aatory reaction of stone "eposits in t#e rena! interstitia!

C#ronic rena!

9 car"in a! signs of inf!a atio n 'yp#  angiti s -ever SAIDS/ .56 Co!c#icine/ C an" ot#er

Progressive inabi!ity to e$crete %ric

S%staine" Uric aci"

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C#ronic *o%ty

Acc%%!ation of onoso"i% %rate in t#e :i"ney

Stag#orn Ca!c%!i

inf!aator y "r%gs

Ac%te Rena!

Contin%e" inf!aation

Obstr%ction/ "i!atation an" atrop#y of ore pro$ia! t%b%!es

Progressive rena! fai!%re

DEA&H

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