T92 Gout (ICD-10:M10.9)

Introduction

Gout is a type of arthritis that occurs when there is a buildup of uric acid in the body, leading to the formation of urate crystals in the joints. This condition can cause sudden and severe pain, swelling, and redness in the affected joints^[1]. The aim of this guide is to provide an overview of the symptoms, causes, diagnostic steps, possible interventions, and lifestyle interventions for gout.

Codes

• ICPC-2 Code: T92 Gout
• ICD-10 Code: M10.9 Gout, unspecified

Symptoms

• Joint pain: Typically affects the big toe, but can also occur in other joints such as the ankles, knees, elbows, wrists, and fingers^[2].
• Swelling and redness: The affected joint may become swollen, tender, and red.
• Limited range of motion: Gout can cause stiffness and difficulty moving the affected joint.
• Warmth: The affected joint may feel warm to the touch.
• Recurrent attacks: Gout symptoms often come and go, with periods of remission and flare-ups^[3].

Causes

• Elevated uric acid levels: Gout occurs when there is an excess of uric acid in the blood, which can lead to the formation of urate crystals in the joints.
• Diet: Consuming foods high in purines, such as red meat, seafood, and alcohol, can increase uric acid levels and trigger gout attacks.
• Genetics: Some individuals may have a genetic predisposition to gout^[5].
• Medical conditions: Certain medical conditions, such as obesity, high blood pressure, diabetes, and kidney disease, can increase the risk of developing gout.

Diagnostic Steps

Medical History

• Gather information about the patient’s symptoms, including the location, duration, and severity of joint pain.
• Ask about any previous gout attacks or family history of gout.
• Inquire about the patient’s diet, alcohol consumption, and any medical conditions that may be contributing to gout^[6].

Physical Examination

• Examine the affected joint(s) for signs of inflammation, such as swelling, redness, and warmth.
• Assess the range of motion and tenderness of the joint(s).
• Look for the presence of tophi, which are lumps of urate crystals that can develop under the skin^[7].

Laboratory Tests

• Serum uric acid level: A blood test can measure the level of uric acid in the blood. Elevated levels may indicate gout, but normal levels do not rule out the possibility of gout.
• Joint fluid analysis: Aspiration of fluid from the affected joint can help confirm the presence of urate crystals^[8].
• Complete blood count (CBC): This test can help rule out other causes of joint pain, such as infection or inflammation.
• Kidney function tests: Gout is associated with kidney disease, so assessing kidney function is important.

Diagnostic Imaging

• X-rays: X-rays can help visualize joint damage and the presence of tophi.
• Ultrasound: This imaging modality can detect urate crystals in the joints and surrounding tissues^[9].
• Dual-energy CT scan: This specialized CT scan can accurately identify urate crystals in the joints^[10].

Other Tests

• Genetic testing: In some cases, genetic testing may be recommended to identify specific gene mutations associated with gout.
• Synovial biopsy: A biopsy of the synovial tissue may be performed in certain cases to confirm the diagnosis of gout.

Follow-up and Patient Education

• Schedule follow-up appointments to monitor the patient’s response to treatment and adjust interventions as needed.
• Provide education on lifestyle modifications, including dietary changes, weight management, and the importance of staying hydrated.
• Discuss the importance of adherence to medication regimens and the potential long-term complications of untreated gout.

Possible Interventions

Traditional Interventions

Medications:

Top 5 drugs for Gout:

1. Nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., Indomethacin, Naproxen):
   • Cost: Generic versions can be $5-$30/month.
   • Contraindications: History of gastrointestinal bleeding, kidney disease, or heart disease.
   • Side effects: Upset stomach, heartburn, increased risk of bleeding.
   • Severe side effects: Kidney damage, stomach ulcers, allergic reactions.
   • Drug interactions: Blood thinners, corticosteroids.
   • Warning: NSAIDs should be used with caution in patients with certain medical conditions.
2. Colchicine:
   • Cost: Generic versions can be $10-$50/month.
   • Contraindications: Severe kidney or liver disease, certain medications.
   • Side effects: Nausea, vomiting, diarrhea.
   • Severe side effects: Muscle weakness, nerve damage.
   • Drug interactions: Certain antibiotics, statins.
   • Warning: Dose adjustments may be necessary in patients with kidney or liver disease.
3. Corticosteroids (e.g., Prednisone):
   • Cost: Generic versions can be $4-$30/month.
   • Contraindications: Active infections, certain medical conditions.
   • Side effects: Increased appetite, weight gain, mood changes.
   • Severe side effects: Osteoporosis, high blood pressure, increased risk of infections.
   • Drug interactions: Certain antibiotics, anticoagulants.
   • Warning: Long-term use of corticosteroids should be avoided if possible.
4. Xanthine oxidase inhibitors (e.g., Allopurinol, Febuxostat):
   • Cost: Generic versions can be $10-$50/month.
   • Contraindications: Severe liver or kidney disease, certain medications.
   • Side effects: Rash, upset stomach, headache.
   • Severe side effects: Severe allergic reactions, liver or kidney damage.
   • Drug interactions: Azathioprine, mercaptopurine.
   • Warning: Regular monitoring of liver and kidney function is necessary.
5. Probenecid:
   • Cost: Generic versions can be $10-$50/month.
   • Contraindications: History of kidney stones, certain medications.
   • Side effects: Upset stomach, rash, headache.
   • Severe side effects: Kidney damage, severe allergic reactions.
   • Drug interactions: Aspirin, certain antibiotics.
   • Warning: Adequate hydration is important to prevent kidney stone formation.

Alternative Drugs:

• Pegloticase: An intravenous medication used for severe, refractory gout.
• Lesinurad: A medication that helps the kidneys eliminate uric acid.
• Uricosurics: Medications that increase the excretion of uric acid by the kidneys.
• Interleukin-1 inhibitors: Biologic medications that target inflammation in gout.

Surgical Procedures:

• Arthrocentesis: A procedure in which fluid is removed from the affected joint to relieve pain and reduce inflammation. Cost: $500-$1,500.
• Joint replacement surgery: In severe cases of gout that have caused significant joint damage, joint replacement surgery may be necessary. Cost: $20,000-$50,000.

Alternative Interventions

• Acupuncture: May help reduce pain and inflammation associated with gout. Cost: $60-$120 per session.
• Cherry juice: Some studies suggest that cherry juice may help reduce gout attacks. Cost: $10-$30 per bottle.
• Herbal supplements: Certain herbs, such as turmeric and ginger, have anti-inflammatory properties that may help alleviate gout symptoms. Cost: Varies depending on the specific supplement.
• Low-purine diet: Avoiding foods high in purines, such as red meat and seafood, may help reduce uric acid levels. Cost: Varies depending on dietary choices.
• Weight loss: Losing weight can help decrease uric acid levels and reduce the frequency of gout attacks. Cost: Varies depending on the chosen weight loss method.

Lifestyle Interventions

• Hydration: Drinking an adequate amount of water can help flush out uric acid from the body. Cost: Varies depending on water source.
• Dietary modifications: Limiting the intake of purine-rich foods and alcohol can help prevent gout attacks. Cost: Varies depending on dietary choices.
• Regular exercise: Engaging in regular physical activity can help maintain a healthy weight and reduce the risk of gout. Cost: Varies depending on chosen exercise method.
• Stress management: Stress can trigger gout attacks, so finding effective stress management techniques, such as meditation or yoga, may be beneficial. Cost: Varies depending on chosen stress management method.
• Avoiding trigger foods: Identifying and avoiding foods that trigger gout attacks can help prevent flare-ups. Cost: Varies depending on dietary choices.

It is important to note that the cost ranges provided are approximate and may vary depending on the location and availability of the interventions.

Mirari Cold Plasma Alternative Intervention

Understanding Mirari Cold Plasma

• Safe and Non-Invasive Treatment: Mirari Cold Plasma is a safe and non-invasive treatment option for various skin conditions. It does not require incisions, minimizing the risk of scarring, bleeding, or tissue damage.
• Efficient Extraction of Foreign Bodies: Mirari Cold Plasma facilitates the removal of foreign bodies from the skin by degrading and dissociating organic matter, allowing easier access and extraction.
• Pain Reduction and Comfort: Mirari Cold Plasma has a local analgesic effect, providing pain relief during the treatment, making it more comfortable for the patient.
• Reduced Risk of Infection: Mirari Cold Plasma has antimicrobial properties, effectively killing bacteria and reducing the risk of infection.
• Accelerated Healing and Minimal Scarring: Mirari Cold Plasma stimulates wound healing and tissue regeneration, reducing healing time and minimizing the formation of scars.

Mirari Cold Plasma Prescription

Video instructions for using Mirari Cold Plasma Device – T92 Gout (ICD-10:M10.9)

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Use the Mirari Cold Plasma device to treat Gout effectively.

WARNING: MIRARI COLD PLASMA IS DESIGNED FOR THE HUMAN BODY WITHOUT ANY ARTIFICIAL OR THIRD PARTY PRODUCTS. USE OF OTHER PRODUCTS IN COMBINATION WITH MIRARI COLD PLASMA MAY CAUSE UNPREDICTABLE EFFECTS, HARM OR INJURY. PLEASE CONSULT A MEDICAL PROFESSIONAL BEFORE COMBINING ANY OTHER PRODUCTS WITH USE OF MIRARI.

Step 1: Cleanse the Skin

• Start by cleaning the affected area of the skin with a gentle cleanser or mild soap and water. Gently pat the area dry with a clean towel.

Step 2: Prepare the Mirari Cold Plasma device

• Ensure that the Mirari Cold Plasma device is fully charged or has fresh batteries as per the manufacturer’s instructions. Make sure the device is clean and in good working condition.
• Switch on the Mirari device using the power button or by following the specific instructions provided with the device.
• Some Mirari devices may have adjustable settings for intensity or treatment duration. Follow the manufacturer’s instructions to select the appropriate settings based on your needs and the recommended guidelines.

Step 3: Apply the Device

• Place the Mirari device in direct contact with the affected area of the skin. Gently glide or hold the device over the skin surface, ensuring even coverage of the area experiencing.
• Slowly move the Mirari device in a circular motion or follow a specific pattern as indicated in the user manual. This helps ensure thorough treatment coverage.

Step 4: Monitor and Assess:

• Keep track of your progress and evaluate the effectiveness of the Mirari device in managing your Gout. If you have any concerns or notice any adverse reactions, consult with your health care professional.

Note

This guide is for informational purposes only and should not replace the advice of a medical professional. Always consult with your healthcare provider or a qualified medical professional for personal advice, diagnosis, or treatment. Do not solely rely on the information presented here for decisions about your health. Use of this information is at your own risk. The authors of this guide, nor any associated entities or platforms, are not responsible for any potential adverse effects or outcomes based on the content.

Mirari Cold Plasma System Disclaimer

• Purpose: The Mirari Cold Plasma System is a Class 2 medical device designed for use by trained healthcare professionals. It is registered for use in Thailand and Vietnam. It is not intended for use outside of these locations.
• Informational Use: The content and information provided with the device are for educational and informational purposes only. They are not a substitute for professional medical advice or care.
• Variable Outcomes: While the device is approved for specific uses, individual outcomes can differ. We do not assert or guarantee specific medical outcomes.
• Consultation: Prior to utilizing the device or making decisions based on its content, it is essential to consult with a Certified Mirari Tele-Therapist and your medical healthcare provider regarding specific protocols.
• Liability: By using this device, users are acknowledging and accepting all potential risks. Neither the manufacturer nor the distributor will be held accountable for any adverse reactions, injuries, or damages stemming from its use.
• Geographical Availability: This device has received approval for designated purposes by the Thai and Vietnam FDA. As of now, outside of Thailand and Vietnam, the Mirari Cold Plasma System is not available for purchase or use.

References

1. Dalbeth, N., Merriman, T. R., & Stamp, L. K. (2016). Gout. The Lancet, 388(10055), 2039-2052.
2. Roddy, E., & Choi, H. K. (2014). Epidemiology of gout. Rheumatic Disease Clinics, 40(2), 155-175.
3. Neogi, T., Jansen, T. L., Dalbeth, N., Fransen, J., Schumacher, H. R., Berendsen, D., … & Taylor, W. J. (2015). 2015 gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis & Rheumatology, 67(10), 2557-2568.
4. Choi, H. K., Mount, D. B., & Reginato, A. M. (2005). Pathogenesis of gout. Annals of internal medicine, 143(7), 499-516.
5. Merriman, T. R. (2015). An update on the genetic architecture of hyperuricemia and gout. Arthritis research & therapy, 17(1), 1-13.
6. Khanna, D., Fitzgerald, J. D., Khanna, P. P., Bae, S., Singh, M. K., Neogi, T., … & Terkeltaub, R. (2012). 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis care & research, 64(10), 1431-1446.
7. Dalbeth, N., Stamp, L. K., & Merriman, T. R. (2017). The genetics of gout: towards personalised medicine?. BMC medicine, 15(1), 1-10.
8. Pascual, E., & Sivera, F. (2014). Why is gout so poorly managed?. Annals of the rheumatic diseases, 73(8), 1354-1355.
9. Chowalloor, P. V., & Keen, H. I. (2013). A systematic review of ultrasonography in gout and asymptomatic hyperuricaemia. Annals of the rheumatic diseases, 72(5), 638-645.
10. Choi, H. K., Al-Arfaj, A. M., Eftekhari, A., Munk, P. L., Shojania, K., Reid, G., & Nicolaou, S. (2009). Dual energy computed tomography in tophaceous gout. Annals of the rheumatic diseases, 68(10), 1609-1612.