What is Gout?
• Crystal arthritis
• Deposition of uric acid crystals in joints
• Presents with acute monoarticular arthritis in 90 %
• Men > Women
• Onset 40-60 years
• Very treatable
• Untreated, may lead to chronic tophaceous gout.
• Pain, swelling and redness of affected joint
• Pain exacerbated by movement
• May be pyrexial
• Podagra is initial presentation in 50 %
• Starts abruptly, max intensity within 8-12
• Resolves spontaneously < 2 weeks
• Gender- male > female
• Family History
• Previous attack
• Body size - large > small
• Diet – purine rich
• Causes of high cell turnover e.g. psoriasis,
• Renal insufficiency
What happens in the joint?
• Supersaturation leads to urate crystal
deposition within joint.
• Leads to inflammatory response
• Joint aspiration - polarising light
microscopy for crystals
• FBC - white cells raised
• ESR - raised
• X-ray - generally normal
• Serum urate
HIGH SERUM URATE DOES NOT NECESSARILY
MEAN THE PATIENT HAS GOUT!
Treatment of Acute Attack
– GI side effects,
– Most effective in 1st
– If NSAID and colchicine contraindicated
AIM- to reduce symptoms
Prevention of Further Attacks
• Lifestyle changes – to minimise risk factors
• Drug therapies
– Xanthine oxidase inhibitors e.g. Allopurinol
– Uricosuric agents e.g. Probenecid
• Need to be taken for life
• Can precipitate an acute attack therefore
give together with NSAID or colchicine for
AIM - Prophylaxis
Site of drug action
Excretion by Kidney
Chronic Tophaceous Gout
• If gout untreated
• Other joint involvement
• Formation of tophi- collection of crystals in
• Bone erosion at joints- ‘punched out’
erosions on x-ray.
• Gout is due to deposition of urate crystals in joints
leading to inflammation.
• Diagnosis is by history and polaroid microscopy
of synovial fluid.
• High serum uric acid does NOT mean the patient
• Gout is one of the most treatable arthritic
• Treat acute attack and then consider prophylaxis
of future episodes.
• If untreated, can develop into chronic tophaceous
• Many predisposing/risk factors
• Typical history
• Treatment - understanding of uric acid
• Chronic tophaceous gout
• Francis M, 2006. eMedicine - Gout.
http://www.emedicine.com/med/topic924.htm. Accessed 10/2/2007
• Andrew J, Herrick A and Marsh D. Musculoskeletal Medicine and
Surgery. Churchill Livingstone, London 2000.
• Underwood J. General and Systemic Pathology Third Edition.
Churchill Livingstone, 2003