At a Glance - Gout

Definition

  • A disorder of purine metabolism characterised by hyperuricaemia and recurrent attacks of synovitis due to urate crystal deposition.

Epidemiology

  • Male preponderance (male:female ratio 8:1); rare in pre-menopausal women.

Acute gout

  • 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.

Chronic gout

  • Soft tissue deposits of urate (tophi) in the pinna, tendons and bursae, leading to joint disruption and progressive disability.

Investigations

  • 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.

Management

  • 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.

Differential diagnosis

  • 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.

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