Antigout Agents
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Antigout Agents
Gout ( ) is a form of inflammatory arthritis characterized by recurrent attacks of pain in a red, tender, hot, and swollen joint, caused by the deposition of needle-like crystals of uric acid known as monosodium urate crystals. Pain typically comes on rapidly, reaching maximal intensity in less than 12 hours. The joint at the base of the big toe is affected (''Podagra'') in about half of cases. It may also result in tophi, kidney stones, or kidney damage. Gout is due to persistently elevated levels of uric acid (urate) in the blood (hyperuricemia). This occurs from a combination of diet, other health problems, and genetic factors. At high levels, uric acid crystallizes and the crystals deposit in joints, tendons, and surrounding tissues, resulting in an attack of gout. Gout occurs more commonly in those who regularly drink beer or sugar-sweetened beverages; eat foods that are high in purines such as liver, shellfish, or anchovies; or are overweight. Diagnosis of gout may ...
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Big Toe
Toes are the Digit (anatomy), digits of the foot of a tetrapod. Animal species such as cats that walk on their toes are described as being ''digitigrade''. Humans, and other animals that walk on the soles of their feet, are described as being ''plantigrade''; ''unguligrade'' animals are those that walk on hoof, hooves at the tips of their toes. Structure There are normally five toes present on each human foot. Each toe consists of three phalanx bones, the Anatomical terms of location#Proximal and distal, proximal, middle, and distal, with the exception of the big toe (). For a minority of people, the little toe also is missing a middle bone. The hallux only contains two phalanx bones, the proximal and distal. The joints between each phalanx are the Interphalangeal joints of foot, interphalangeal joints. The proximal phalanx bone of each toe articulates with the metatarsal bone of the foot at the Metatarsophalangeal joints, metatarsophalangeal joint. Each toe is surrounded by ...
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Colchicine
Colchicine is a medication used to prevent and treat gout, to treat familial Mediterranean fever and Behçet's disease, and to reduce the risk of myocardial infarction. The American College of Rheumatology recommends colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs) or steroids in the treatment of gout. Other uses for colchicine include the management of pericarditis. Colchicine is taken by mouth. The injectable route of administration for colchicine can be toxic. In 2008, the US Food and Drug Administration removed all injectable colchicine from the US market. Colchicine has a narrow therapeutic index, so overdosing is a significant risk. Common side effects of colchicine include gastrointestinal upset, particularly at high doses. Severe side effects may include pancytopenia (low blood cell counts) and rhabdomyolysis (damage to skeletal muscle), and the medication can be deadly in overdose. Whether colchicine is safe for use during pregnancy is unclear, ...
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Synovial Joint
A synovial joint, also known as diarthrosis, joins bones or cartilage with a fibrous joint capsule that is continuous with the periosteum of the joined bones, constitutes the outer boundary of a synovial cavity, and surrounds the bones' articulating surfaces. This joint unites long bones and permits free bone movement and greater mobility. The synovial cavity/joint is filled with synovial fluid. The joint capsule is made up of an outer layer of fibrous membrane, which keeps the bones together structurally, and an inner layer, the synovial membrane, which seals in the synovial fluid. They are the most common and most movable type of joint in the body. As with most other joints, synovial joints achieve movement at the point of contact of the articulating bones. They originated 400 million years ago in the first jawed vertebrates. Structure Synovial joints contain the following structures: * Synovial cavity: all diarthroses have the characteristic space between the bones that is f ...
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Purine
Purine is a heterocyclic aromatic organic compound that consists of two rings (pyrimidine and imidazole) fused together. It is water-soluble. Purine also gives its name to the wider class of molecules, purines, which include substituted purines and their tautomers. They are the most widely occurring nitrogen-containing heterocycles in nature. Dietary sources Purines are found in high concentration in meat and meat products, especially internal organs, such as liver and kidney, and in various seafoods, high-fructose beverages, alcohol, and yeast products. Examples of high-purine food sources include anchovies, sardines, liver, beef, kidneys, brains, monkfish, dried mackerel, and shrimp. Foods particularly rich in hypoxanthine, adenine, and guanine lead to higher blood levels of uric acid. Foods having more than 200 mg of hypoxanthine per 100 g, particularly animal and fish meats containing hypoxanthine as more than 50% of total purines, are more likely to increase uri ...
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Tendon
A tendon or sinew is a tough band of fibrous connective tissue, dense fibrous connective tissue that connects skeletal muscle, muscle to bone. It sends the mechanical forces of muscle contraction to the skeletal system, while withstanding tension (physics), tension. Tendons, like ligaments, are made of collagen. The difference is that ligaments connect bone to bone, while tendons connect muscle to bone. There are about 4,000 tendons in the adult human body. Structure A tendon is made of dense regular connective tissue, whose main cellular components are special fibroblasts called tendon cells (tenocytes). Tendon cells synthesize the tendon's extracellular matrix, which abounds with densely-packed collagen fibers. The collagen fibers run parallel to each other and are grouped into fascicles. Each fascicle is bound by an endotendineum, which is a delicate loose connective tissue containing thin collagen fibrils and elastic fibers. A set of fascicles is bound by an epitenon, whi ...
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Hyperuricemia
Hyperuricaemia or hyperuricemia is an abnormally high level of uric acid in the blood. In the pH conditions of body fluid, uric acid exists largely as urate, the ion form. Serum uric acid concentrations greater than 6 mg/dL for females, 7 mg/dL for males, and 5.5 mg/dL for youth (under 18 years old) are defined as hyperuricemia. The amount of urate in the body depends on the balance between the amount of purines eaten in food, the amount of urate synthesised within the body (e.g., through cell turnover), and the amount of urate that is excreted in urine or through the gastrointestinal tract. Hyperuricemia may be the result of increased production of uric acid, decreased excretion of uric acid, or both increased production and reduced excretion. Signs and symptoms Unless high blood levels of uric acid are determined in a clinical laboratory, hyperuricemia may not cause noticeable symptoms in most people. Development of gout which is a painful, short-term d ...
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Urate Nephropathy
Acute uric acid nephropathy (AUAN, also acute urate nephropathy) is a rapidly worsening (decreasing) kidney function (acute kidney injury) that is caused by high levels of uric acid in the urine (hyperuricosuria). Causes Acute uric acid nephropathy is usually seen as part of the acute tumour lysis syndrome in patients undergoing chemotherapy or radiation therapy for the treatment of malignancies with rapid cell turnover, such as leukemia and lymphoma. It may also occur in these patients before treatment is begun, due to spontaneous tumor cell lysis (high incidence in Burkitt's lymphoma). Acute uric acid nephropathy can also be caused by an acute attack of gout. Pathophysiology Acute uric acid nephropathy is caused by deposition of uric acid crystals within the kidney interstitium and tubules, leading to partial or complete obstruction of collecting ducts, renal pelvis, or ureter. This obstruction is usually bilateral, and patients follow the clinical course of acute kidney failur ...
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Kidney Stone
Kidney stone disease (known as nephrolithiasis, renal calculus disease, or urolithiasis) is a crystallopathy and occurs when there are too many minerals in the urine and not enough liquid or hydration. This imbalance causes tiny pieces of crystal to aggregate and form hard masses, or calculi (stones) in the upper urinary tract. Because renal calculi typically form in the kidney, if small enough, they are able to leave the urinary tract via the urine stream. A small calculus may pass without causing symptoms. However, if a stone grows to more than , it can cause blockage of the ureter, resulting in extremely sharp and severe pain ( renal colic) in the lower back that often radiates downward to the groin. A calculus may also result in blood in the urine, vomiting (due to severe pain), or painful urination. About half of all people who have had a kidney stone are likely to develop another within ten years. ''Renal'' is Latin for "kidney", while "nephro" is the Greek equiva ...
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Tophus
A tophus (Latin: "stone", : tophi) is a deposit of monosodium urate crystals, in people with longstanding high levels of uric acid (urate) in the blood, a condition known as hyperuricemia. Tophi are pathognomonic for the disease gout. Most people with tophi have had previous attacks of acute arthritis, eventually leading to the formation of tophi. Chronic tophaceous gout is known as Harrison Syndrome. Tophi form in the joints, cartilage, bones, and other places throughout the body. Sometimes, tophi break through the skin and appear as white or yellowish-white, chalky nodules. Without treatment, tophi may develop on average about ten years after the onset of gout, although their first appearance can range from three to forty-two years. The development of gouty tophi can also limit joint function and cause bone destruction, leading to noticeable disabilities, especially when gout cannot successfully be treated. When uric acid levels and gout symptoms cannot be controlled with s ...
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Hallux
Toes are the digits of the foot of a tetrapod. Animal species such as cats that walk on their toes are described as being ''digitigrade''. Humans, and other animals that walk on the soles of their feet, are described as being ''plantigrade''; '' unguligrade'' animals are those that walk on hooves at the tips of their toes. Structure There are normally five toes present on each human foot. Each toe consists of three phalanx bones, the proximal, middle, and distal, with the exception of the big toe (). For a minority of people, the little toe also is missing a middle bone. The hallux only contains two phalanx bones, the proximal and distal. The joints between each phalanx are the interphalangeal joints. The proximal phalanx bone of each toe articulates with the metatarsal bone of the foot at the metatarsophalangeal joint. Each toe is surrounded by skin, and present on all five toes is a toenail. The toes are, from medial to lateral: * the first toe, also known as the h ...
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Metatarsophalangeal Joint
The metatarsophalangeal joints (MTP joints) are the joints between the metatarsal bones of the foot and the proximal bones (proximal phalanges) of the toes. They are analogous to the knuckles of the hand, and are consequently known as toe knuckles in common speech. They are condyloid joints, meaning that an elliptical or rounded surface (of the metatarsal bones) comes close to a shallow cavity (of the proximal phalanges). The region of skin directly below the joints forms the Ball (foot), ball of the foot. The ligaments are the plantar and two collateral. Movements The movements permitted in the metatarsophalangeal joints are flexion, Extension (kinesiology), extension, List of abductors of the human body, abduction, List of adductors of the human body, adduction and Circumduction (anatomy), circumduction. File:The feet of C. H. Unthan, the armless fiddler Wellcome L0034227.jpg, Left: toes adducted (pulled towards the center) and spread (abducted); right, both feet clenched (p ...
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Monosodium Urate Crystals
Uric acid is a heterocyclic compound of carbon, nitrogen, oxygen, and hydrogen with the Chemical formula, formula C5H4N4O3. It forms ions and salts known as urates and acid urates, such as ammonium acid urate. Uric acid is a product of the metabolic breakdown of purine nucleotides, and it is a normal component of urine. Hyperuricemia, High blood concentrations of uric acid can lead to gout and are associated with other medical conditions, including diabetes and the formation of ammonium acid urate kidney stones. Chemistry Uric acid was first isolated from kidney stones in 1776 by Swedish chemist Carl Wilhelm Scheele. In 1882, the Ukrainian chemist Ivan Horbaczewski first synthesized uric acid by melting urea with glycine. Uric acid displays lactam–lactim tautomerism. Uric acid crystallizes in the lactam form, with computational chemistry also indicating that tautomer to be the most stable. Uric acid is a diprotic acid with pKa, p''K''a1 = 5.4 and p''K''a2 =&nbs ...
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