- A disorder of purine metabolism characterised by hyperuricaemia and recurrent attacks of synovitis due to urate crystal deposition.
- Male preponderance (male:female ratio 8:1); rare in pre-menopausal women.
- Sudden severe joint pain lasts for one to two weeks if untreated.
- Most commonly affects the first metatarsophalangeal joint, ankle and
- finger joints, although other joints may also be involved.
- Affected joints are inflamed and exquisitely tender.
- Triggers include alcohol, thiazide diuretics, trauma and surgery.
- Soft tissue deposits of urate (tophi) in the pinna, tendons and bursae, leading to joint disruption and progressive disability.
- ESR, CRP and serum uric acid may be raised.
- Synovial fluid microscopy reveals negatively birefringent crystals
- under polarised light.
- X-rays show peri-articular 'punched-out cysts' in chronic gout.
- Acute episodes should be treated with a combination of rest and
- high-dose NSAIDs.
- Systemic corticosteroids and colchicine are suitable alternatives.
- Allopurinol can be used for prophylaxis in those with recurrent attacks, but never for treatment of acute exacerbations.
- Septic arthritis is an important differential diagnosis. If in doubt,
- admit for further investigations.
- Myeloproliferative disorders and renal failure both result in hyperuricaemia. Gout may be a presenting feature of these conditions.
- Contributed by Dr Aziz Sheikh, professor of primary care research and development, Division of Community Health Sciences, GP section, University of Edinburgh.