Gout

Abnormality in uric acid metabolism causing hyperuricemia

Aged over 40 years mainly affected

More common in males

Predisposing factors

Alcohol Xs

Trauma

Surgery

Dehydration

Chronic kidney disease

Drugs- (frusemide, thiazide)

Leukaemia

Hypothyroidism

Clinical features

Joint pain

Tenosynovitis

Urate stones

Red swollen, hot, and tender joint

Joints involved (MTP joint great toe most commonly affected Other joints involved- other toes, ankle, knees, DIP joint fingers)

Investigation

Urate- increased levels, could be normal

Synovial fluid aspirate—uric acid crystals

X-ray – punched out lesions

Management

Non-pharmacological

Patient education

Alcohol cessation/cutdown

Weight reduction

A normal well-balanced diet

Avoid purine-rich food (liver, brain, kidney, tinned fish)

Reduced intake of soft drinks

Adequate hydration (2 litres/day)

Avoid drugs such as (diuretics)

Pharmacological

NSAIDs

Indomethacin

Colchicine

Intra-articular corticosteroid injection

Allopurinol for prophylaxis