Gout

Question 1

Etiology

Answer 1

hyperuricemia
caused by altered purine metabolism
Metabolism by-product of purine catabolism
Monosodium urate crystal deposits in the joint, kidneys, soft tissue
However, having hyperuricemia does not guarantee the development of gout

Question 2

Symptoms

Answer 2

Begins with involvement of a single joint or multiple joints of the lower extremities most often the first metatarsophalangeal (Podagra), midtarsal, ankle, or knee joints
Unilateral pain, erythema, and swelling with frequent, recurrent acute attacks with fever & elevated WBC’s
Attacks peak in 48-72 hours, often starting in the am and last up to 5-7 days, with or without treatment
Not considered gouty arthritis until consistent acute attacks

Question 3

Dx

Answer 3

Synovial fluid analysis - gold standard
Frequent or chronic Gout can produce Tophi (deposits of monosodium urate crystals in the soft tissue) can develop on the helix of the ears, over the olecranon process and over the IP joints- can be seen on x-rays as well
Serum uric acid can be done but there is no guarantee that it will correspond

Question 4

Tx

Answer 4

Goal symptomatic control and risk factor modification with pharmacotherapy prevention for recurrence
Pharmacologic:
NSAIDs, corticosteroids and Colchicine for acute attacks
Allopurinol for chronic urate-lowering regimen to be withdraw during acute attacks
If pt is on a diuretic consider change of therapy
Non-pharmacologic
Diet modification (less red meat, seafood, organ meat)
Decrease ETOH
Weight loss