GOUT

Question 1

History

Answer 1

• Male (20:1)
• Obesity
• Excessive alcohol intake
• Positive family history
• Diet high in purines (shellfish, meat, sardines)
• High SES
• Medications (diuretics and salicylates)
  Stereotypical patient
• Male >30 years
• Obese
• Red faced
• Hypertensive
• Fond of alcohol
  Look for triggering event
• Recent chemotherapy
• Recent surgery
• Recent joint injury
• Stress
• Excessive food intake
  Acute onset
• Attack occurs within hours or during the course of one day
• Often at night

Question 2

Signs and symptoms of Stage 1 & 2

Answer 2

Stage 1: asymptomatic deposition of crystals
Stage 2: acute gouty arthritis
-	Only one or a few joints affected
-	Commonly 1st MCP (75% Podagra)
-	Toes fingers hands feet and knees
-	Less frequently hips shoulders elbows
-	Rapid onset severe pain (throbbing, crushing)
-	Extreme tenderness
-	Hot 
-	Swollen
-	Erythematous and shiny
-	Joint stiffness and reduced ROM
Extra articular manifestation
-	Periarticular swelling and tenderness
-	Malaise, fever, chills
-	Bursitis
-	Atypical presentation may present with heel or sole tenderness

Question 3

Signs and symptoms of stage 3 & 4

Answer 3

Stage 3: Intercritical
- Still a build up of crystals
- Most individuals will suffer another attack within the first year
Stage 4: Chronic tophaceous gout
- More likely to occur when disease starts before 30
- Occurs usually 10 years after first acute episode
Chronic inflammation leads to destruction
- Chronic joint pain (milder)
- Reduced ROM
- Pronounced stiffness
- Redness and swelling not as severe
- Deformity
- Occasional acute flare ups

Question 4

Extra-articular manifestations

Answer 4

Tophi
-	1mm to several cm in diameter
-	Over 1st MCP, Achilles tendon, olecranon bursa and pinnae
-	Skin over other joints
-	Can appear anywhere
Complications
Renal involvement, look for ssx of
-	Urolithiasis
-	Renal failure