MEDICAL INSIDER
DR CORA LIM
FOR MAY 14, 2023
Applied Rheumatology Made Simple (A.R.M.S.)
(Part 7 )
Let us now focus our discussion on gouts, the diet of people who
have gouts, hyperuricemia, monoarthritis, the septic joint and the
arthritis-rash syndromes.
Gout and the Diet
The following should be taken into consideration when we talk
about the gout and the diet.
Purine content in the diet does not usually contribute to more
than 1.0 mg/dl to SUA concentration.
Moderation in dietary purine consumption (rather than a
constant low purine diet) is indicated in those who habitually
eat large amounts of purine-containing food.
Consumption of large amounts of food containing a small
concentration of purines provides a greater purine load than
consumption of a small amount of food containing a large
purine load.
Hyperuricemia and when to treat it
What is hyperuricemia? This is a condition of person who has too
much uric acid in the blood. This condition can lead to health
problems such as gout and kidney stones. Around one out of
every five people has a high uric acid level. When do we treat
hyperuricemia?
When the cause cannot be corrected e.g. obesity,
hypertension. Hypercholesterolemia
When there have been 2 or 3 definite gout attacks
When there is tophaceous gout
When the Urinary calculi and/or urinary UA number to 800
mg/day
When there is Tumor lysis (risk of acute uric acid
nephropathy)
Differential diagnoses for monoarthritis
What is meant by differential diagnoses? It is a process of
differentiating between two or more conditions which share similar
signs or symptoms. What is meant by monoarthritis? It is an
inflammation of one joint that may later involve other joints of the
body. Differential diagnoses for monoarthritis include: Gout,
Pseudogout, Septic arthritis, Reactive arthritis, Trauma and
Beginning polyarthritis. And let us not overlook the septic joint. If
there is fever before and during monoarthritis, this suggests septic
arthritis. If theire is persistent monoarthritis (and fever) despite
NSAIDs or colchicine, this suggests septic arthritis. Remember, in
case of doubt, treat as septic arthritis because gout and septic
arthritis can co-exist!
Let us also talk about Arthritis – rash syndromes. The presence of
cutaneous manifestations in a patient with arthritis provides a
useful aid in the diagnosis. Some arthritis-rash syndromes: Viral
arthritis, Reiter’s, Psoriatic arthritis, Rheumatic fever, Henoch-
Schonlein purpura, Systemic lupus erythematosus and other
vasculitides and CTDs Aaa