Table of Contents
Gout is a monoarthropathy caused by deposition of monosodium urate crystals in hyperuricaemia.
Hyperuricaemia risk factors
- Male gender
- Chronic kidney disease
- Diuretics
- Purine rich diet: alcohol, meat, seafood
- Obesity
Clinical features
- Tender, inflamed joint
- Usually a monoarthritis
- Commonly affects first metatarsophalangeal joint
- Other joints include ankles, knees, wrists, finger joints
- Arthralgia worse at night
- Acute episodes last around 2 weeks
- Other features of hyperuricaemia
- Gouty tophi
- Renal nephrolithiasis
Investigations
- Bloods: uric acid level (hyperuricaemia seen in gout, but uric acid level may be falsely low or normal during attack)
- Needle aspiration of synovial fluid – gold standard
- Send for polarising microscopy
- Send for microbiology: to rule out septic arthritis
- X-Ray
Management
- Treat cause
- Lifestyle: keep hydrated, avoid purine rich food/drink, avoid fasting, lose weight
- Medication review: thiazides and loop diuretics can trigger gout
- Acute management: NSAIDs, colchicine or corticosteroids
- Prevention with urate-lowering therapies: consider starting allopurinol or febuxostat if multiple flares, gouty tophi or arthritis, CKD, or on diuretics (NB: starting urate-lowering therapy can trigger an acute episode of gout so wait 2-4 weeks after an acute flare and offer colchicine cover for first 1-3 months)
Reference: NICE ‘NG219 Gout: diagnosis and management’ 2022
Questions
What are the classical features of gout on an X-ray?
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What is pseudogout?
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What are the findings of gout and pseudogout on polarising microscopy?
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