Gout is an essential medical topic as it is frequently encountered in exams as well as clinical practice.
Gout is the most common inflammatory arthritis in men and older women. It is caused by the deposition of monosodium urate monohydrate crystals in and around synovial joints.
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Gout
Gout is caused by which type of crystals?
Monosodium urate monohydrate crystals. These are negatively birefringent needle-shaped crystals when seen under polarized light.
What is Podagra? Which joints are commonly involved in gout?
Podagra is the involvement of the first metatarsophalangeal joint. It occurs in > 50% cases. Other common joints are the ankle, foot, small joints of the hand, wrist, elbow, or knee. Gout can be polyarticular.
Who is affected more? Males or Females?
Males are more commonly affected. Male: Female – 4:1
What is the pathophysiology of gout?
Gout is caused by the deposition of monosodium urate monohydrate crystals in and around joints, which causes inflammation.
What factors can precipitate an acute attack of gout?
Gout can be precipitated in a prone person (hyperuricemia) by trauma, surgery, starvation, infection, or diuretics.
In acute terms, gout can cause painful inflammatory arthritis. What are the long-term sequelae of gout?
In long term, gouty tophi and renal disease can occur. Tophi are the urate deposits occurring in different parts of the body, commonly in ear pinna, muscle tendons and joints. Renal effects of gout include renal calculi and interstitial nephritis.
Risk factors for the development of gout: Gout can occur either due to reduced excretion or excessive production.
- Reduced urate excretion occurs in Elderly, men, post-menopausal females, impaired renal function, hypertension, metabolic syndrome, thiazide diuretics, and aspirin.
- Excess urate production occurs with certain consumptions like alcohol, sweeteners, red meat and seafood, drugs like warfarin and cytotoxics, myeloproliferative and lymphoproliferative disorders, tumour-lysis syndrome, and psoriasis.
What is the differential diagnosis of gouty arthritis?
If acute monoarthritis, exclude SEPTIC ARTHRITIS. Other differentials to consider are reactive arthritis, hemarthrosis, Calcium pyrophosphate dihydrate crystal deposition disease (CPPD) and palindromic rheumatoid arthritis
What are the common associations of gout?
Cardiovascular disease, hypertension, diabetes mellitus, and chronic kidney disease (CKD). Screen for and treat these conditions, if present.
Which tests will you do to diagnose?
The diagnostic test is Polarized light microscopy of synovial fluid demonstrating negatively birefringent urate crystals. Serum uric acid is usually raised but may be normal. Radiographs: During early stages, x-rays show only soft-tissue swelling. Later on, well-defined ‘punched out’ erosions are seen in the juxta-articular bone. In gout, joint spaces are preserved until late and there is no sclerotic reaction.
What is the treatment of acute gout?
Rest and elevate the joint. Ice packs and ‘bed cages’ can be effective. High-dose NSAID or colchicine, if NSAIDs are contraindicated. Steroids (oral, IM, or intra-articular) may also be used. Joint aspiration in some cases.
How to prevent gout attacks, renal disease and chronic tophaceous gout?
Prevention is done through losing weight in obese individuals, and avoidance of precipitating factors like prolonged fasts, alcohol excess, purine-rich meats, and low-dose aspirin. Prophylactic medications are started if there is more than one attack in 12 months, presence of tophi, or renal stones.
What are the types of prophylactic medications?
There are 2 broad categories. Xanthine oxidase inhibitors (Allopurinol, Febuxostat) reduce the production of uric acid. The other category is of Uricosuric drugs (Probenecid, Benbromarone, Sulphinpyrazone) to increase urate excretion.
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Gout – All That You Need to Know About It
Courtesy: Last Second Medicine