Gout

Question 1

Define:

Answer 1

A disorder of uric acid metabolism causing recurrent bouts of acute arthritis caused by deposition of monosodium urate crystals in joints, soft tissues and kidneys

Question 2

Aetiology:

Answer 2

Increased uptake:

• Dietary (red meat, shellfish, anchioves)
• Increased nucleic acid turnover
• Increased purine synthesis

Decreased renal excretion:

• Idiopathic
• Dehydration
• Alcohol excess
• Drugs
• Renal dysfunction

Hyperuracemia >6.8mg\dl
- Urate crystal deposit in the joints leading to pain and inflammation

Question 3

Risk factors:

Answer 3

Obesity 
Alcohol
Diabetes 
Chemotherapy
Radiation 
CVD
HTN

Question 4

Epidemiology:

Answer 4

10x more common in males
Very rare in pre-pubertal and post-menopausal
More common in higher social classes

Question 5

Precipitating factors:

Answer 5

Trauma
Infection 
Alcohol
Starvation 
Surgery 
Diuretics
Induction or withdrawal of hypouricaemic agents

Question 6

Symptoms/signs:

Answer 6

• Sudden excruciating monoarticular pain
 Usually affecting the metatarsophalangeal joint of the great toe (podagra)
• Symptoms peak at 24 hrs
• They resolve over 7-10 days
• Sometimes, acute attacks can present with cellulitis, polyarticular or periarticular involvement
• Attacks are often recurrent
• Patients are symptom-free between attacks

Question 7

Signs of chronic trophaceous gout:

Answer 7

o Follow repeated acute attacks
o Symptoms:
• Persistent low-grade fever
• Polyarticular pain with painful tophi (urate deposits)
 Best seen on tendons and the pinna of the ear
o Symptoms of urate urolithiasis (renal calculi symptoms)

Question 8

Investigations:

Answer 8

Synovial fluid aspirate -will show monosodium urate crystals (theses are needle shaped + -ve bifringent)

M C & S - to exclude septic arthritis

FBC - increased WCC
U+Es
Increased Urate
Increased ESR

AXR/KUB film - to check for uric acid renal stones.