Curriculum · Musculoskeletal / Orthopedic / Rheumatology
Gout
What it is
Gout is a type of crystal arthropathy associated with chronically high blood uric acid levels. Urate crystals are deposited in the joint, which becomes hot, swollen and painful. Gout in the first metatarsophalangeal joint is called podagra.
Causes and risk
The risk factors are male sex, obesity, a high purine diet of meat and seafood, alcohol, diuretics with the dehydration they bring, existing cardiovascular or kidney disease and a family history. The drugs that precipitate it are given as FACT: furosemide, aspirin in low dose and alcohol, cyclosporine and thiazide diuretics. The foods are given as SALT: seafood, alcohol as beer and spirits, and liver and kidney. Excessive alcohol and red meat consumption, hypertension and renal failure sit in the same history, and thiazides should be asked about, because they can precipitate gout. Peak incidence falls at 30-60 years, and the course is chronic with acute attacks.
How it presents
It typically presents with a single acute hot, swollen and painful joint, and the pain, oedema and erythema develop acutely, classically overnight. It is usually a monoarthritis of a large joint affecting the first metatarsophalangeal joint, but it can affect any joint and can be polyarticular. The typical joints are the base of the big toe at the metatarsophalangeal joint, the wrists and the base of the thumb at the carpometacarpal joints, and it also reaches the knee and the ankle. In the hands the DIP joints are the most affected. Gouty tophi are subcutaneous deposits of uric acid, typically in the small joints and connective tissues of the hands, the elbows and the ears. The joint is inflamed: swollen, erythematous and warm.