Gout

132 Gout

Instruction

Examine this patient’s hands or examine the feet.

Salient features

History

• Usually acute pain at the base of great toe, worse at night and associated with redness

• Occasionally multiple joints involved

• Systemic symptoms, e.g. low grade fever.

Examination

• Chronic tophaceous deposit with asymmetrical joint involvement.

Proceed as follows:

• Tell the examiner that you would like to examine:

• the helices of the ears

• the elbow for olecranon bursae

• the Achilles tendons for tophi

• the feet or hands.

• Uric acid crystals are negatively birefringent, needle shaped and may be deposited in bursae and bone marrow. They are demonstrable in synovial fluid within leukocytes and free in the fluid during attacks of gouty arthritis. They react with nitric acid and ammonium hydroxide to give a purple colour (murexide test).

• Be prepared to discuss the differences between the clinical features of typical gout and gout in the elderly.

Diagnosis

This patient has a painful great toe with swelling of the joint (lesion) caused by gout (aetiology) and is unable to walk because of the pain (functional status).

Questions

What is the basic pathophysiology of gout?

Gout is a metabolic disorder of purine metabolism. It is characterized by hyperuricaemia caused by either overproduction (75%) or underexcretion (25%) of uric acid.

What are the different clinical manifestations of gout?

• Asymptomatic hyperuricaemia

• Acute arthritis

• Chronic arthritis

• Chronic tophaceous gout (Figs 132.1 and 132.2).

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Tags: 250 Cases in Clinical Medicine

Dec 4, 2016 | Posted by admin in GENERAL & FAMILY MEDICINE | Comments Off

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