Essay: Concise Analysis of Gout Presentation

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[. . .] FNAC (fine needle aspiration cytology) is an economical and safe technique to diagnose soft peri-articular tissue nodules. Pathologists ought to be aware of the correct cytomorphological characteristics for gouty tophi's differential diagnosis. Another clinical diagnosis to consider was 2nd-degree kidney failure. But investigations revealed serum creatinine and blood urea nitrogen within normal levels. Hence, uric acid crystal precipitation is not clear and gouty tophi commonly occur at such sites. Differential diagnosis of tophaceous pseudo gout and tumor calcinosis may be made here, since radiographs of both reveal calcification of soft tissue. FNAC represents an inexpensive and straightforward diagnostic tool to diagnose the source of periarticular nodules' nature. A second advantage of FNAC is its excellent crystal preservation. In subcutaneous nodulediagnosis, chalky, white granular matter is extracted onto the FNAC (Vijay Kumar, Chakravarthy, Vartak, & Hemant Haria, 2015).

Treatment Modalities

i. Imaging

Imaging has a diagnostic role to play in the identification of tophi being presented in the form of mass lesions. It also aids the identification of symptoms of substantial pain and movement constraints in soft surface tissues (such as ankle tendons, carpal tunnel and patellar tendon) and deeper structures (such as spinal and knee cruciate ligament). Ultrasounds effectively identify carpal tunnel flexor tendon tophi which resolve with appropriate treatment to reduce serum uric acid; imaging may be done subsequent to progressive resolution (Girish, et al., 2013).

ii. Multi-disciplinary Approach

Therapy entails a multidisciplinary strategy which involves dermatologists, internists, rheumatologists, and nutrition experts. General measures adopted are weight reduction, dietary changes, adequate exercise and reduced alcohol consumption. Pharmacological treatments include steroids, analgesics, allopurinol, and colchicine. The need for surgery depends on patient disability level and the compression of adjacent structures. Multiple extensive lesions restrict surgical treatment modality efficacy but surgical excision might be employed in instances refractory to medication. Of late, mammalian pegylated recombinant uricase, pegloticase, has been proven to work effectively in reducing levels of urate and swiftly decreasing tophus size among tophaceous chronic gout patients (Piyush, Anupam, Sushil, Rajesh, & Shahid, 2015).

Patient Education

Gout management necessitates a complex approach. Rheumatologists have, of late, set a target of achieving long-term concentration of serum urate at less than 6 milligrams/deciliter, thereby fostering dissolution of crystals and preventing new crystal formation (Saigal & Agrawal, 2015).

Instruction on lifestyle and diet changes forms a key component of gout patient education. Patients must be advised to:

1. Attain ideal weights

1. Quit smoking

1. Adopt a nutritious diet with optimal exercise and

1. Remain well hydrated

Additionally, they need to abstain from seafood, kidney, liver, lamb and calf pancreas and thymus and other purine-rich meat, fruits such as organs and apples, fructose rich drinks (e.g., ice creams, corn syrup, and sweetened cold drinks), rich heavy meals, and alcohol. Foods to be consumed in limited amounts include lamb, beef, pork, sea food sweetened beverages, natural sugars, table salts and desserts and alcohol (vitamin C consumption is linked to decreased levels of serum urate and urate urolithiasis risk factors (Saigal & Agrawal, 2015).

References

Assuncao, P., Giampietro, R., Paiva, S., & Okoshi, M. (2014). Untreated tophaceous gout. International Journal of Case Reports and Images, 89 - 91.

Center, S. C.-b. (2016). Diagnosis of Gout. Agency for Healthcare Research and Quality.

Girish, G., Melville, D., Kaeley, G., Brandon, C., Goyal, J., Jacobson, J., & Jamadar, D. (2013). Imaging Appearances in Gout. Hindawi Publishing Corporation, 10.

Javeed Ahmed, S., & Khurshid, S. (2013). Polyarticular tophaceous gouty arthritis: A case report. International Journal of Case Reports and Images, 554 - 558.

Piyush, K., Anupam, D., Sushil, S., Rajesh, M., & Shahid, H. (2015). Gout nodulosis: report of a rare case and brief review. Dermatology Online Journal.

Saigal, R., & Agrawal, A. (2015). Pathogenesis and Clinical Management of Gouty Arthritis. Journal of The Association of Physicians of India, 56 - 63.

Vijay Kumar, P., Chakravarthy,… [END OF PREVIEW]

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