Gout

Clinical Features

Acute onset, hot, red, painful, swollen metatarsophalangeal joint of the great toe Gouty tophi are common in ears, bursae and tendon sheaths Fever Prodrome   Anorexia Nausea Change in mood

Investigations

Synovial fluid aspiration   Examined under polarising light Negatively birefringent crystals Serum Urate   Elevated, but not diagnostic, as asymptomatic hyperuricaemia is very common FBE   Mild leukocytosis ESR & CRP X-Ray   Punched out erosions Soft tissue swelling (tophi)

Treatment

Acute attacks   NSAIDs   Indomethacin Naproxen Colchicine Prophylactic   Allopurinol   Must be administered with colchicine, as can precipitate acute gout attack Must not be administered until several weeks after acute attack Inhibits xanthine oxidase Uricosuric agents (Probenecid)   Increases urinary excrition of uric acid   Avoidance of salicylates