Gout

Question 1

What is the definition of gout?

Answer 1

Defect in metabolism of uric acid causing arthritis

Question 2

How common is gout?

Answer 2

Prevalence of gout is 1.4%

Question 3

What is the pathophysiology of gout?

Answer 3

• > 50% occur at the metatarsophalangeal joint of the big toe
• Deposition of precipitated monosodium urate crystals in and near joints – less soluble under acid and low temperatures
• Due to too much uric acid/urate in the blood
• Urate deposits = tophi in pinna (outside the ear), tendons and joints
• Renal disease (stones and interstitial nephritis) may also occur

Question 4

What is the aetiology/risk factors for gout?

Answer 4

• Men
• Trauma
• Surgery
• Starvation
• Infection
• Diuretics
• Hereditary
• ↑ diet purines – meats mainly
• Alcohol
• Leukaemia
• CV disease
• Hypertension
• Diabetes
• Chronic renal failure

Question 5

What are the signs/symptoms of gout?

Answer 5

• Swollen
• Tender
• Erythematous
• Fever
• Malaise
• Difficulty using the affected joints
• Pressure ↑ pain exponentially
• Maximum pain after before 24 hours
• Tophi – draining or chalk like subcutaneous nodule under skin

Question 6

What diseases does gout present similarly to?

Answer 6

• Septic arthritis
• Haemarthrosis
• CPPD
• Palindromic RA

Question 7

What investigations would be needed to diagnose gout?

Answer 7

• ↑ plasma/serum urate
• Polarised light microscopy of synovial fluid – shows urate crystals
• 24h urine sample
• Fasting glucose
• Fasting lipids
• X-Ray: soft tissue swelling initially the well punched out erosions seen in bone
• US: double contour sign

Question 8

What are the pharmacological treatments for gout?

Answer 8

• High dose NSAID
• Colchicine
• Allopurinol – prevention
• Febuxostat – prevention
• Steroids – oral/IM/intra-articular

Question 9

What are the non pharmacological treatments for gout?

Answer 9

• Rest and elevate the affected joint – e.g. bed cage to keep foot elevated at night
• Ice packs
• Lose weight
• Avoid prolonged fasts
• Reduce alcohol consumption
• Reduce purine rich meats