Gout

Question 1

What is gout?

Answer 1

Gout is a a disease in which defective metabolism of uric acid causes arthritis, especially in the smaller bones of the feet, with episodes of acute pain

Question 2

What causes gout?

Answer 2

• Elevated serum urate - urate is not metabolised in the kidney which leads to crystal formation
• Local factors - irritation to the leg, eg stasis
• High fructose drinks -
• High dietary purines - found in a lot of foods
• Dehydration - concentrate your blood etc
• Medications - dehydration-causing meds
• Familial - genetic

Question 3

What are the signs and symptoms of gout?

Answer 3

• Severe joint pain, classicly in big toe
• Joint inflammation or redness
• Soft tissue swelling (feather test)
• Red, shiny, warm skin
• Soft nodules (tophi)
• Joint deformity in the long term
• Fever during relapses

Complications if not managed, include:
* Joint damage
* Renal damage including Kidney stones
* Bones - loss & fractures including oesteoporsis
* Eyes and blood vessels - aorta can get damaged
* Widespread tophi

Question 4

What is the pathophysiology of gout?

Answer 4

The presence of monosodium urate (MSU) crystals in joints, bones, and soft tissues.

Results in a cascade of problems:
* Acute arthritis (a gout flare)
* Chronic arthritis (chronic gouty arthritis)
* Tophi (tophaceous gout) - accumulation of uric crystals
* UA crystals in the joint cavity is the trigger for gout
* An inflammatory process is initiated by the crystals, leading to synovial phagocytic cells leading to release of lysosomal enzymes and inflammatory chemokines. Body is trying ot breakdown the crystals, but failing, and get stuck in an inflammatory cycle.

Question 5

What is typical diagnotic tests and treatment for gout?

Answer 5

Diagnostic investigations
* Maybe obvious eg hot toe, weight etc
* Joint fluid aspiration for urate crystals - needle removes fluid for tests
* Blood test (results can be misleading as may not match clinical picture; show low uric acid)
* X-ray imaging to see bone erosions, Ultrasound, Computerised Tomography scan (CT).

Conventional treatment of GOUT
* Nonsteroidal anti-inflammatory drugs (NSAIDs)
* Corticosteroids
* Colchicine
* Allopurinol
* Bisphosphonates to prevent osteoporosis - in long term can contribute to the gout, so used with caution
* Other drugs to prevent complications

Dietary and lifestyle management
* Increase fluids intake - dilute the blood
* Reduce alcohol and sugars
* Reduce purine containing foods - eg seafood, shellfish, anchovies, sardines, herrings, mussels, cod, scallops, trout and haddock. Also red meats, bacon