DEFINITION OF THE DROP

Gout is associated with tissue deposition of monosodium urate due to abnormal metabolism of uric acid. His translation is mainly articular and renal.

INFORMATION ON THE DROP

- It is common,

- It is seen mainly in men (90% of cases) and only occurs in women after menopause,

- It is seen most often between 30 and 50 years with the man she does never before puberty.

- Usually, this is a drop primitive expression favored by overeating or drugs (diuretics, ...).

Sometimes it is a drop secondary to:

Renal,
Blood disease (myeloproliferative disorder, leukemia)
Lead poisoning
Medication (thiazide diuretics, cyclosporin A, pyrazinamide).

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THE CAUSES OF GOUT?

1) The overhead is essentially tied in uric gout primitive to an exaggeration of the endogenous synthesis of purines, including uric acid is the ultimate catabolite.

Indeed, among the other factors that may increase the 'pool of uric acid, the exaggeration of tissue catabolism is not involved, while increased dietary purine intake and reduced renal elimination play a secondary role or casual.

2) The reasons for this "runaway" of the endogenous synthesis of uric acid remain poorly defined.

Uric acid comes from the metabolism of nucleotides. The first step in the degradation of nucleoproteins is regulated by the phosphoribosyl pyrophosphate synthetase (PRPP synthetase). Nucleotides are then converted into nucleosides, which are themselves metabolized into uric acid. Uric acid comes from xanthine by xanthine oxidase. Purines can be converted into nucleotides, particularly hypoxanthine guanine phosphoribosyl transferase (HGPRT).
The exact mechanism of metabolic derangement in the usual drop primitive adult remains unknown although it is assumed enzyme abnormality. By cons drops enzymopathies are known: the HGPRT deficiency leads to a unique form of gout that is seen in infants (Lesch and Nyhan) and other disturbances are rarely described as overactive PRPP synthetase .

CLINICAL STUDY ON THE DROP

Gout results in acute and chronic manifestations must be studied separately.

Acute gout

Initial translation of the disease, acute gout results in painful crises and fluxionary that:

* Occasionally occur under specific conditions,
* Are sometimes heralded by premonitory symptoms,
* Usually sit at the big toe,
* But can be seen in other joints,
* And sometimes even outside of the joints.

1) - Conditions of occurrence

It often occurs without apparent cause, but sometimes after a gap of diet, overwork, trauma, surgery or taking certain medications (thiazide diuretics ...).

2) - The prodromal

They are fickle:

* General: malaise, sub-febrile temperature,
* Visceral: insomnia, irritability, constipation, anorexia, dysuria, renal colic.
* Local: tingling, swollen veins.

3) - The crisis of the big toe

This is the most typical manifestation. This is the mode of onset of the disease 2 out of 3. It concerns the first metatarsophalangeal joint.

a) The typical crisis

The onset is sudden (often in the middle of the night), for severe pain, to kind of tear, shred, causing cutaneous hyperesthesia making it very painful and unbearable contact sheets or examination of local and accompanied a genuine impotence preventing the patient from getting up.

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