Gout

Question 1

Pathomechanism of Gout

Answer 1

Deposition of monosodium urate crystals in joints that lead to inflammation.
Usually occurs in Hyperuricemia :
■ Increased production of uric acid: increased cell turnover (tumor lysis
syndrome, hemolysis), Lesch-Nyhan syndrome.

■ Decreased removal of uric acid (most common cause): renal disease,
NSAIDs, diuretics, acidosis.

Question 2

Symptoms of Gout

Answer 2

Usually occurs in men age 40-60.

Occurs in “attacks” - sudden onset intense joint pain, often waking up
in sleep. Usually affects the big toe first, first MTP joint (podagra). Also
affects ankles, knees, elbows. Causes inflammation, swelling,
tenderness, warmth. +/- fever.

Most people have another attack within 1-2 years.

Question 3

Diagnosis of Gout

Answer 3

Joint aspiration, synovial fluid analysis under polarizing microscope.
Needle-shaped negatively birefringent urate crystals.

Question 4

Treatment of Gout

Answer 4

Avoid meds that increase uric acid (thiazides, loop diuretics), reduce
alcohol, reduce dietary purines (seafood/red meat)

■ Acute gout: rest, start with NSAIDs. If ineffective, use colchicine (but
high amount of side effects - N/V/D). If cannot take them, then use
oral steroids. Intra-articular steroids also very effective.

■ Prophylaxis for tumor lysis syndrome: hydration, allopurinol, maybe
rasburicase.