Gout

Question 1

What is gout?

Answer 1

Disorder of uric acid metabolism causing recurrent bouts of acute arthritis

Question 2

What is the underlying pathology?

Answer 2

Desposition of urate crystals in joint and ensuing acute inflammatory response

Question 3

What is the underlying disturbance?

Answer 3

Hyperuricaemia

Question 4

Give examples of a) increased production and b) reduced excretion of uric acid.

Answer 4

a) (Rarer) Red meat, seafood, alcohol, haemolytic disorders, psoriasis
b) (most cases)- renal impairment, hypothyroidism, diuretics, cytotoxics

Question 5

What is the typical history of an attack of gout?

Answer 5

Sudden excruciating monoarticular joint pain with erythema and swelling, peaking at 24hrs

Question 6

What may happen following repeated attacks of gout?

Answer 6

Chronic tophaceous gout; deposits of uric acid crystals producing firm, chalky nodules around the extensor surfaces of fingers, hands, elbows

Question 7

What is the main investigation in suspected gout?

Answer 7

Synovial fluid aspirate- presence of sodium urate crystals (needle shaped and negatively birefringent)

Question 8

What should be excluded and how is this done?

Answer 8

Septic arthritis - microscopy and culture of synovial fluid

Question 9

How is gout treated a) acutely and b) prophylactically

Answer 9

a) NSAIDs, colchicine, intra-articular steroids

b) allopurinol (start 2-4 weeks after acute attack), febuxostat

Question 10

What is pseudogout?

Answer 10

Deposition of calcium pyrophosphate crystals within a joint

Question 11

How is pseudogout treated?

Answer 11

NSAIDS, colchicine, steroids