Epidemiology clinical features and Comorbidities in Gout.

Kirthi, R (2008) Epidemiology clinical features and Comorbidities in Gout. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : Gout is an inflammatory arthritis mediated by crystallization of uric acid within the joints. Gout has been called the king of kings and the disease of kings. The term gout introduced in the thirteenth century is derived from the Latin word “Gutta” a drop and reflects the early belief that a poison falling drop by drop into the joint was responsible for the disease. Hippocrates described gout as podagra, chiegra, gonagra depending on the site of involvement, the foot the wrist or the knee. Tophi were first described by Galen. Thomas Sydenham’s unsurpassed description marked the modern clinical history of gout. Wollartanin (1797) and Pearson (1798) demonstrated urate in the tophi of patients with gout. Leeuwenhock the inventor of the microscope first described these crystals in 1679. In 1848 Garrod demonstrated an increased amount of uric acid in the blood of gouty patients. AIMS AND OBJECTIVES : 1. To study the epidemiological characteristics of various patients of gout. 2. To study the musculoskeletal features and biochemical characteristics in them. 3. To analyze the comorbidities in these patients. MATERIALS AND METHODS : Seventy consecutive patients of gout who attended the department of rheumatology, Madras Medical College were included in the study. This is a Prospective Study conducted between January 2006 and March 2008. Inclusion Criteria: A definitive diagnosis of gout was established by demonstration of intracellular uric acid crystals in the synovial fluid or tophi. When crystals could not be demonstrated diagnosis was established if six of the twelve American rheumatism association (ACR) criteria were fulfilled. Exclusion Criteria: Patients of psoriasis, Systemic lupus erythematosus and hematological malignancies with elevated uric acid levels were excluded from the study. Methods: All patients were asked for a detailed history which includes the duration of the disease, disease onset, the first joint affected, the duration of the attack, the time interval between subsequent episodes, whether it was a persistent arthritis, and time of onset of first MTP joint involvement .A history of other illnesses such as coronary artery disease, hypertension, hypothyroidism and consumption of alcohol was asked for. A detailed general examination, height, weight and body mass index was calculated. A musculoskeletal system examination and other systems were done. RESULTS : Seventy patients of gout were analyzed of which 57 were males and 13 were females. Five patients belonged to the group of young onset gout (< 30 Yrs) and all of them were males. The mean age of patients of young onset was 25.3 ± 5.08 yrs. with a 't' value of 4.966 which was of high statistical significance. The mean age of males in late onset group was 45.32 ± 11.65 yrs. and females was 48 ± 7.93 yrs. There was no statistically significant difference in age distribution among sexes (t value of 0.788). 38 patients (55.5%) gave history of alcohol consumption, of which 37 are males. CONCLUSION : Majority of the patients (79%) of gout in our study belonged to the age group of 31-60 years. * Predominant pattern of arthritis was polyarticular. * Five patients in our study belong to the Young onset group. * Dyslipidemia and Hypertension were the common co morbidities in the male population. * Hypertension, Dyslipidemia and Hypothyroidism were the common co-morbidities in our female patients. * A strong association between polyarticular gout and renal failure was noticed. * Serum uric acid levels were higher in males than females. * There was a significant correlation between uric acid levels and serum creatinine. * The 24 hours uric acid excretion was higher in tophaceous gout than the non tophaceous gout.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Epidemiology ; clinical features ; Comorbidities ; Gout.
Subjects: MEDICAL > Rheumatology
Depositing User: Subramani R
Date Deposited: 16 Aug 2017 00:48
Last Modified: 16 Aug 2017 07:01
URI: http://repository-tnmgrmu.ac.in/id/eprint/1831

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