GOUT BA or OA lang?

Allan D. Corpuz, MD, FPCP, DPRA Section of Rheumatology Department of Medicine

IT RMC

Ano ang rheumatology? •  Arthritis like Gout, Rheumatoid Arthritis,

Osteoarthritis, Spondyloarthritis •  Musculoskeletal/Soft Tissue Rheumatisms like

Tendinitis, Bursitis, Fasciitis •  Autoimmune and Connective Tissue Diseases like

Lupus, Scleroderma, Myositis •  Vasculitis

HINDI lahat ng rayuma ay gout

•  Mayroong mga 100 klase ng rayuma

•  Hindi lang joints ang nirarayuma •  Ang rayuma ay maaring isang:

–  Arthritis like Gout, Rheumatoid Arthritis, Osteoarthritis, Spondyloarthritis

–  Musculoskeletal/Soft Tissue Rheumatisms like Tendinitis, Bursitis, Fasciitis

–  Autoimmune and Connective Tissue Diseases like Lupus, Scleroderma, Myositis

–  Vasculitis

Dahil HINDI gout lahat ng rayuma…

•  Hindi sila pare-pareho ng presentasyon

•  Iba-iba rin ang gamot ng bawat rayuma

•  Hindi dahil nawawala ang sakit sa pain reliever ay okay na

•  May mga rayuma na nakakamatay or nakaka-disable

•  Dapat lahat ng rayuma ay kinokonsulta sa isang RHEUMATOLOGIST

TOP 4 na Arthritis •  OA (Osteoarthritis) •  Gout •  RA (Rheumatoid Arthritis) •  SPA (Spondyloarthritis)

OA ang pinakamadalas

•  Tuhod, Kamay •  Balakang •  Likod •  Sakit ng matanda (40 pataas) •  Masakit halos araw-araw •  Di halos namaga •  Mababang level ng sakit •  Masakit pag ginagalaw •  Naninigas pag hindi naigalaw •  Masakit sa pagtayo, pagbaba,

pag-squat

Ang RA ay deforming at disabling

•  Autoimmune •  Masakit araw araw •  May halong

pamamaga •  Di sapat ang pain

reliever •  Didikit or

madedeform ang joints

Ang SPA ay maraming klase

•  Maaring sumunod sa UTI or pagtatae (Reactive Arthritis)

•  Maaring makita sa mga bata (Juvenile form)

•  Maaring magsimula as chronic low back pain (Ankylosing Spondylitis)

•  Maaring may kasamang rashes (Psoriatic arthritis)

Pero Gout ang pinakamasakit

•  Nakakaapekto sa BIG joints; usually SINGLE joint sa una, dumadami habang tumatagal

•  Episodic (meaning: hindi araw-araw) •  Madalas sa lalaki, mga 20 pataas •  Bihira sa babae, unless postmenopausal •  Namamaga, minsan mapula, sobrang sakit kahit mahipan lang •  Mawawala, babalik

The 5 stages of gout •  Asymptomatic hyperuricemia: mataas uric acid,

walang arthritis •  Acute Gout: simula ng arthritis, maiksi ang tagal, di

madalas •  Intercritical Gout: quiet phase •  Chronic Gout: dumadalas ang atake, humahaba ang

tagal •  Chronic Tophaceous Gout: nagkakabukol na

Podagra ang usual na unang atake

Minsan nagtutubig ang tuhod

Bumubukol pag tumatagal

•  Pag hindi nagamot or inom lang ng inom ng pain reliever, nawawala ang sakit pero di ang problema (Chronic Tophaceous Gout)

Di dapat pinapa-operahan ang mga bukol

•  Maaring hindi gumaling •  Maaring maimpeksyon •  Nagagamot ito ng oral

medications

Sa gout lang may bawal na pagkain

•  Hindi lahat ng rayuma may bawal na pagkain •  Gout lang ang common na metabolic arthritis

The Gouty Diet

Food Group Low Purine 0-50mg purine/100g

Eat as desired

Moderate Purine 50-150 purine/100g

Eat in moderation

High Purine 150-825mg purine/100g

Avoid eating

Breads, Cereals & Grain Products

White Bread Corn Bread Noodles/Pasta Macaroni Popcorn

Spaghetti White Rice Crackers Puddings/Custards Rice

Wheat Bread Oatmeal Wheat bran

Wheat germ Brown Rice Whole grains

Sweetbreads Yeast (Baker’s and Brewer’s)

Fruit All Fruits and Fruit Juices

Vegetables Most vegetables (except those noted in next column) Vegetable soups made w/o meat stock

Asparagus Cauliflower Spinach

Mushrooms Green Peas

Meats, Poultry, Fish, and Protein Foods

Eggs Peanut Butter Nuts (Walnut, Almond, Peanut)

Lean Meat (beef, pork, lamb) Poultry without skin Tofu

Fish Shellfish (shrimp, crab, oysters, clams)

Sardines Mackerel Anchovies Herring Organ Meats (liver, kidney, brain, heart, intestines) Meat Extracts Mincemeat

Dried beans (red bean, munggo bean, soybean, black eye peas, lentils, etc) Mussels Scallops

Milk and Milk Products

All low fat or fat free milk and dairy products Cheese

Others Carbonated beverages Chocolate Coffee and Tea

Fats and Oils Condiments Salt Olive/Pickles

Meat Soups and Broth Beer and Alcoholic Products Gravies

Eating During Acute Attack Eating in Remission Consume 8-16 cups of fluid daily, at least half water Abstain from alcohol (discuss with M.D.) Avoid fruit juice and sugared soft drinks (diet sodas are okay) Limit animal foods of meat, fish, and poultry to 4 to 6 oz./day Eat protein in moderation: low-fat or nonfat dairy, tofu, eggs, and nut butters, such as peanut butter or almond butter, are preferred

Consume 8 to 16 cups of fluid daily, at least half water Limit alcohol intake (discuss with M.D.) Limit/avoid fruit juice and sugared soft drinks (diet sodas are ok) Consume a healthy low-fat diet, with moderate amounts of protein. Visit MyPyramid.gov and click on MyPyramidPlan link for daily intake guidelines Maintain a healthy body weight. Avoid fasting or high-protein diets for weight loss

Don’tsuffertoolong…

CONSULT YOUR RHEUMATOLOGISt J

When in GOUT, Consult a Rheumatologist