CASE STUDY SCRIPT

Faye: Good day! To all of you and to you sir Jhumerzon. Our case study for today is all about the Gout.

Before we discuss the different information we have researched. Here are the following the things that
we will speak about.

First we have the overview of the disease, its symptoms, the causes, its risk factors, different
complications, preventions, diagnosis such as techniques to determine the disease and lastly we shall
also discuss about the treatments for gout.

Miss de asis can you please give us a short description of what gout is?

Madric: *read the slide

Faye: So what is gout?

Gout is a metabolic disorder which causes inflammation of the joints.  A metabolic disorder occurs when
the metabolism process fails and causes the body to have either too much or too little of the essential
substances needed to stay healthy.

It’s due to a tiny needle- shaped crystals called uric acid. It is a common and complex form of arthritis
that can affect anyone. Gout is characterized by sudden, severe attacks of pain, swelling, redness and
tenderness in one or more joints, most often in the big toe.  Severe gout can sometimes affect many
joints at once. This is known as poly-articular gout.

Most people with gout experience critical attacks every now and then, often waking up in the middle of
the night with the sensation that their big toe is on fire. There are some cases that Months or even years
can pass between attacks. The inflammation normally goes away on its own within one to two weeks
and the pain can be relieved with medication. There are a number of options to prevent them. Some
people already notice an improvement if they avoid certain foods and other possible triggers. Others
may take medication to lower their uric acid levels over the long term. The medication is mostly
considered for people who have frequent gout attacks or complications such as kidney stones or lumps
called tophi.

And did you know

Gout has the unique distinction of being one of the most frequently recorded medical illnesses
throughout history.

Although, there are cases where many people have high levels of uric acid without it causing any
noticeable problems. It's not yet proven to be clear whether this affects their health or not.

Mister Cantor can you please elaborate the different symptoms for people who have gout?

Greg:

Trechia:

CAUSES OF GOUT:

Gout is a common and complex form of arthritis that can affect anyone. It's characterized by sudden,
severe attacks of pain, swelling, redness and tenderness in one or more joints, most often in the big toe.
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An attack of gout can occur suddenly, often waking you up in the middle of the night with the sensation
that your big toe is on fire. The affected joint is hot, swollen and so tender that even the weight of the
bedsheet on it may seem intolerable. There are many different factors that can give causes to have gout
disease, and these are: Eating foods that can cause the buildup of uric acid: Purines are also found in
certain foods, including red meat and organ meats, such as liver. Purine-rich seafood includes anchovies,
sardines, mussels, scallops, trout and tuna. Alcoholic beverages, especially beer, and drinks sweetened
with fruit sugar (fructose) promote higher levels of uric acid.

Unhealthy body/lifestyle: having an unhealthy diet/ lifestyle can also trigger the possible attacks of
acute gout. If you're overweight, your body produces more uric acid and your kidneys have a more
difficult time eliminating uric acid. Organ complications: Certain diseases and conditions increase your
risk of gout. These includes chronic conditions such as obesity, diabetes, metabolic syndrome, and heart
and kidney diseases.

Having a close relative with gout: This kind of disease can be also inherited by any family member that
have gout disease/ or has a background of having serious attacks of this. A person is more likely to
develop such disease because it may run into the bloodlines of the whole family.

NEXT RISK FACTORS (DE ASIS)

Madric:

Cheene:

1. Gout and Tophi - Tophi are clumps of urate crystals and inflammatory cells that form under the skin
when you have gout. They are more likely to occur in people with gout for a longer period of time or
whose gout is not well-controlled. Gout tophi can occur in the hands, feet, wrists, ankles, eyes, ears,
nose, and even heart valves.

2. Gout and Kidney Stones Kidney stones are one of the most common gout complications. They affect
about one in five people with gout. If urate crystals collect and build in your urinary tract, they can form
kidney stones.

Symptoms of kidney stones include:

 Severe pain in the side and back below the ribs

3. Gout and Kidney Disease According to the National Kidney Foundation, many people with gout also
have chronic kidney disease (CKD). This sometimes ends in kidney failure.

One in 10 people with chronic kidney disease have gout, and an even higher percentage of people with
gout have kidney disease. Initial symptoms of kidney disease include tiredness, weakness, and
decreased energy,

4. Gout and Heart Disease Gout and cardiovascular disease commonly occur together. Patients who had
gout at any point during the study had a two-fold increased risk of heart failure death compared to
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people who never developed gout. Gout causes inflammation in the joints and the rest of the body;
inflammation is also a risk factor for heart disease.

Heart Disease prevention strategies may include:

*Heart-healthy Diet

*Regular exercise and

* Better cardiovascular assessment

5. Gout and Diabetes Annals of the Rheumatic Disease found that gout may be independently associated
with an increased risk of type 2 diabetes. If you’re overweight or obese, you’re more likely to have both
gout and type 2 diabetes. Excessive alcohol consumption can also contribute to both gout and diabetes.

Maintaining healthy eating and exercise habits can prevent and manage diabetes and gout. Foods low in
calories and fat but high in fiber (fruits, veggies and whole grains) can help lower your risk of diabetes.

6. Gout and Sleep Issues

* Pain from gout can prevent you from falling back to sleep. Since gout attacks often happen at night,
people with gout are awoken from sleeping.

That sleep deprivation can lead to increased stress, mood swings, fatigue, and other health problems.

7. Gout and Mental Health the chronic pain associated with repeated gout attacks can lead to stress,
anxiety, and depression. Gout can cause severe pain that can make it tough for you to get around, go to
work, and complete daily tasks. That impact on your daily life can impacts patients’ mental, social, and
physical well-being.

8. Gout and Bone Loss When you have gout, you’re more prone to osteopenia and osteoporosis
factures. In the early phases of thinning bones, called osteopenia, and even in more advanced
osteoporosis, people don’t have symptoms unless they develop a bone fracture.

“That’s why it’s important for women at the time of menopause and men with gout or other
osteoporosis risk factors to get a bone density test

AND HERES MISS DELA CRUZ TO EXPLAIN GOUT PREVENTION…

Trechia and Greg:

Thank you Ms. bernardo

PREVENTION:

In preventing such pain scenarios, there are some ways on how gout disease and how can severe gout
pains be prevented. Being dehydrated and continuous maintenance of fluid can help prevent the acute
gout attacks, and can also lessen the formation of kidney stone in people with the gout disease. Dietary
plans can also help in reducing the uric acid in the blood. In such dietary plans, weight loss progress can
also play an important part in order to lower the risks of recurrent possible attacks of gout. In the
making of the Diet plan it is important to avoid alcohol consumption, drink plenty of water, lose weight,
treat sleep apnea, take prescription and etc. here are some of the strategies that may at least lessen the
CASE STUDY SCRIPT

possible gout attacks. If gout runs in the family, men in particular should limit their intake of alcohol,
fats, and foods that are more likely to increase uric acid level in the body meat, sardines, bacon,
mussels, and yeast. Alcohol, especially beer, can also bring on an attack of gout. Such men should watch
their weight with extra care. Drinking plenty of liquids may help minimize the risk of kidney stones. 

Medications can also help prevent gout attacks in people with multiple attacks of gout. These drugs
either decrease the production of uric acid in the body or increase the excretion of uric acid in urine. 

Now may I call on Ms. De Asis to provide info for the diagnosis of gout disease.

Madric:

Faye: In terms of the treatment it has two aims

-In the short term, it should provide relief from pain whenever your gout, attacks.

-In the long term, it should prevent further attacks and lower the risk of chronic inflammations and joint
damage.

We have first the remedies you can do at home

• Drink Plenty of Water- to remain well-hydrated can be beneficial in preventing gout attacks.

Drinking plenty of water is important to kidney function. Keeping the kidneys in good shape can also
reduce uric acid crystal buildup and gout attacks.

• Avoid drinking Alcohol- Alcohol is known to have diuretic effects that can contribute to
dehydration and precipitate acute gout attacks

It causes gout by slowing down the discharge of uric acid from the kidneys as well as by causing
dehydration, which causes the crystals in the joints.

• Changing your diet: Especially eating less meat, fish and seafood

You should avoid triggers and keep a good gout diet because it is an important remedy in and of itself.

Studies show red meat, seafood, sugar, and alcohol are the most likely triggers. Stick to low-sugar fruits,
vegetables, whole grains, nuts, legumes, and low-fat dairy instead.

• Get plenty of rest- Gout attacks can interfere with movement and mobility.

To avoid worsening the pain, relax and stay put while joints are inflamed.

• Also, cooling the affected joint probably also helps, and most people find it very soothing.

• Taking Over-the-counter nonsteroidal anti-inflammatory drugs - such as ibuprofen and naproxen

Medication is mainly used if the attacks become more frequent or are very distressing. You may also
start to take it if complications such as tophi or kidney stones have already developed, or if the
functioning of the kidney is affected. Medication might also be an option if changes to your diet or home
remedies aren’t enough to ease the pain.

To further elaborate the usage of medication, we have Miss bernardo

Cheene:

Medications for the treatment of gout generally fall into one of three categories: uric-acid-lowering
medications, prophylactic medications, and rescue medications to provide immediate relief from gout
pain.

Uric Acid Lowering Medication

These medications decrease the total amount of uric acid in the body and lower the serum uric acid
level. For most patients, the goal of uric-acid-lowering medication is to achieve a serum uric acid level of
less than 6 mg/dl. These medications also are effective treatments to decrease the size of tophi, with the
ultimate goal of eradicating them. Uric-acid-lowering medications include allopurinol febuxostat,
probenecid, and pegloticase.

allopurinol side effects include fever, rash, hepatitis, and kidney problems. Febuxostat side effects
include rash, nausea, and reduced liver function. Febuxostat also may increase the risk of heart-related
death. Drugs such as probenecid (Probalan) help improve your kidneys' ability to remove uric acid from
your body. Side effects include a rash, stomach pain and kidney stones.

Prophylactic medications This is because any medication or intervention that either increases or
decreases the uric acid level in the bloodstream can trigger a gout attack. Colcrys and any of the NSAIDs
(nonsteroidal anti-inflammatory drugs) such as indomethacin, diclofenac ibuprofen, or naproxen sodium
are frequently used as prophylactic medications to prevent gout flares during uric-acid lowering. By
taking one of these prophylactic or preventative medications during the first six months of treatment
with allopurinol, febuxostat, or probenecid, the risk of having a gout attack during this time is decreased.
Prophylactic medications are not used in combination with Krystexxa.

THIRD MEDICATIONS . Both Colcrys and NSAIDs can be used during an acute gout attack to decrease
inflammation and pain. Corticosteroids such as prednisone, methylprednisolone (Medrol), and
prednisolone (Orapred), also can be used during an acute gouty flare. However, the total dose of
steroids is generally limited due to potential side effects such as cataract formation and bone loss.
Steroid medications are extremely helpful in treating gout flares in patients who are unable to take
Colcrys or NSAIDs

CLOSING: trechia

And that brings us to the end, I’d like to thank you for your time and attention. Our group sincerely
appreciate your interest and attention. We are gladly taking some time to dig deeper with regards this
case study. Once again, we are group 1 and thank you for listening!