Gout.
History:
Age of the patient?
H/o pain, stiffness (morning or evening). Swelling and redness.
Any other joints are involved?
Weight? Diet? (red meat, fish, offal precipitates.)
H/o skin rash, genital and oral ulcers. Fever?
Excessive exercise and starvation.
H/o trauma, surgery and infection.
H/o alcohol consumption. Past history of similar complaint?
H/o DM, HTN, IBD, polycythaemia, leukemia, renal failure.
Hypothyroidism and hyperparathyroidism.
Use of drugs like diuretics, aspirin, cytotoxics.
F/h Gout.
The metatarsophalangeal joint of the big toe is usually effected. Attacks are due to hyperuricaemia and the deposition of sodium monourate crystals in the joints.
Diagnosis: microscopy of synovial fluid: negatively birefringent crystals, x-rays: soft tissue swelling and punched out lesions in the bone. The joint spaces are preserved until late.
Treatment: acute gout: NSAID such as Naproxen. If contraindicated eg. Peptic ulcer, give Colchicine.
Prevention: avoid purine rich foods, obesity and alcohol excess. No aspirin. Consider reducing serum urate with long term Allopurinol.
DD for joint swelling: trauma, septic arthritis, seronegative arthritides and Gout.