Gout

Question 1

A 55 year old male presents to the clinic with a complaint of recurrent episodes of joint pain and swelling that usually affects his left big toe. He also shows you his elbow.

Please state this clinical sign

Answer 1

Gouty tophi

Question 2

The doctor suspects gouty tophi a sign of gout. Please explain what gout is.

Answer 2

Gout is an inflammatory condition resulting from defective purine metabolism leading to an
increased production of uric acid. As the uric acid concentration increases in the blood,
supersaturation and precipitation occurs, forming crystals of monosodium urate in the
synovial cavity of joints, in tendons and in the surrounding tissues.

Question 3

Please identify the structure that lies directly underneath the gouty tophi

Answer 3

Olecranon

Question 4

The GP prescribes the patient naproxen. How will this drug help with gout?

Answer 4

It is a cyclooxygenase inhibitor, inhibits the production of prostaglandins which can reduce pain and inflammation. In gout, the inflammatory response is triggered by the deposition of urate crystals in the joint, which causes the release of cytokines and other inflammatory mediators.

Question 5

Rheumatoid nodules can also develop on the elbow just like gouty tophi. Please identify and state the X-ray signs seen with rheumatoid arthritis.

Answer 5

Question 6

Rheumatoid arthritis can also damage the eyes leading to dryness, redness and sensitivity to light.

Point to and state which part of the eye is most commonly affected in rheumatoid arthritis

Answer 6

Conjunctiva