Skip to main content

GOUT

 Introduction:

Gout is caused by the deposition of monosodium urate monohydrate (MSUM) crystals at synovial joints. It has a prevalence of 1–2%, and is more common in men, in certain ethnic groups and with increasing age. Uric acid mainly comes from the metabolism of purines within the body but some is ingested with food. Gout is becoming more common with increased longevity and prevalence of metabolic syndrome, of which hyperuricaemia is a component.

 


Clinical features

Acute gout: This presents with rapid onset of severe pain in a single distal joint, commonly the first metatarsophalangeal joint. Other common sites include the ankle, midfoot, knee, hand, wrist and elbow. Examination reveals marked synovitis with swelling, red shiny skin and extreme tenderness. Periarticular swelling and fever may also be present. Symptoms are usually selflimiting over 5–14 days. The differential diagnosis includes septic arthritis, cellulitis and reactive arthritis.

 


Recurrent and chronic gout: Following an acute attack, many patients go on to experience a second attack within a year. The frequency of attacks increases with time. Involvement of several joints with continued MSUM deposition eventually leads to joint damage and chronic pain. 

Chronic tophaceous gout: MSUM crystal deposits produce irregular firm nodules (‘tophi’) around extensor surfaces of fingers, forearms, elbows, Achilles tendons and ears. Tophi are usually a late feature of gout.

Renal and urinary tract manifestations: Chronic hyperuricaemia may be complicated by renal stone formation and sometimes renal impairment due to interstitial nephritis caused by urate deposition in the kidney. This particularly affects patients with chronic tophaceous gout who are on diuretics.



Investigations

Joint aspiration reveals long, needle-shaped MSUM crystals, which are negatively birefringent under polarised light. Synovial fluid in acute gout appears turbid due to the high neutrophil count (> 90%). Serum uric acid is usually elevated, but hyperuricaemia itself does not confirm gout. Equally, acute inflammation reduces levels, so a normal uric acid level does not exclude gout. Serum creatinine should be checked to exclude renal impairment. There is neutrophilia with a raised CRP in acute gout; FBC and ESR may detect myeloproliferative disorders during remission of the acute episode.

Joint X-rays are usually normal in early gout. Changes of secondary OA and gouty erosions may develop with chronic disease.

 

Management

Acute attacks: Oral NSAIDs are standard treatment. Ice packs provide symptomatic relief. Oral colchicine is also very effective but vomiting and diarrhoea are common side-effects. Joint aspiration and intra-articular corticosteroid injections are effective in more severe cases.

Long-term management: Allopurinol lowers serum uric acid levels by inhibiting xanthine oxidase, which reduces conversion of hypoxanthine and xanthine to uric acid. It is indicated in patients with recurrent attacks of acute gout, tophi, joint damage or renal impairment. Allopurinol initiation can trigger an acute attack; it should therefore be initiated after the acute attack has settled, and should be co-prescribed with an NSAID or colchicine for the first few weeks.

 

Predisposing factors should be addressed:

● Weight loss: advised in obese patients.

● Excess beer: avoid.

● Diuretics: stop if possible.

● High-purine diet (seafood, red meat and offal): avoid.

Comments

Synergy Physiotherapy Clinic said…
This article gives impressive information. Anyone looking for Fitness physiotherapy in Bangalore city, can check out here
March 28, 2023 at 5:35 PM
Post a Comment

Popular posts from this blog

BRONCHIECTASIS

INTRODUCTION: Bronchiectasis means abnormal dilatation of the bronchi due to chronic airway inflammation and infection. It is usually acquired, but may result from an underlying genetic or congenital defect of airway defences. CAUSES: Congenital • Cystic fibrosis • Primary ciliary dyskinesia • Kartagener’s syndrome (sinusitis and transposition of the viscera) • Primary hypogammaglobulinaemia Acquired • Pneumonia (complicating whooping cough or measles) • Inhaled foreign body • Suppurative pneumonia • Pulmonary TB • Allergic bronchopulmonary aspergillosis complicating asthma • Bronchial tumours CLINICAL FEATURES: ● Chronic cough productive of purulent sputum.  ● Pleuritic pain. ● Haemoptysis.  ● Halitosis. Acute exacerbations may cause fever and increase these symptoms. Examination reveals coarse crackles caused by sputum in bronchiectatic spaces. Diminished breath sounds may indicate lobar collapse. Bronchial breathing due to scarring may be heard in advanced disease. INVESTIG...
Post a Comment
Read more

CARDIAC ARREST AND RESUSCITATION

INTRODUCTION: The leading causes of sudden death before old age, in people over the age of 44, are ventricular fibrillation from asymptomatic ischaemic heart disease or non-traumatic accidents such as drowning and poisoning. In people under the age of 38, the commonest causes are traumatic, due to accident or violence. In such instances death may be prevented if airway obstruction can be reversed, apnoea or hypoventilation avoided, blood loss prevented or corrected and the person not allowed to be pulseless or hypoxic for more than 2 or 3 minutes. If, however, there is circulatory arrest for more than a few minutes, or if blood loss or severe hypoxia remain uncorrected, irreversible brain damage may result. Immediate resuscitation is capable of preventing death and brain damage. The techniques required may be used anywhere, with or without equipment, and by anyone, from the lay public to medical specialists, provided they have been appropriately trained. Resuscitation may be divided in...
Post a Comment
Read more

Acute Torticollis (Twisted Neck)

  Torticollis – another name for having a ‘twisted neck’ or a ‘wry neck’ – often happens suddenly. You go to bed without any symptoms one night and then you simply wake up the following morning with a wry neck. This is known as acute torticollis. It is a very common cause of neck pain and stiffness. However, although it can be very painful when you are affected by it, most people with the condition do not actually need to see their doctor, as simple treatment such as painkillers, physiotherapy can be really effective. symptoms Developing a wry neck (acute torticollis) occurs when the muscles supporting your neck on one side become painful. These symptoms usually come on very quickly, often overnight, so that you wake up with pain and stiffness down one side of your neck. The pain is usually just on one side of your neck and stiffness of the muscles in that area twists the neck to one side. You may find it very difficult when you try to straighten your neck, due to pain. Occasional...
Post a Comment
Read more