Gout Overview and Clinical Features

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Questions and Answers

What is the primary biochemical abnormality associated with gout?

Deficiency of uric acid

Abnormality of uric acid metabolism (correct)

Increased levels of creatinine

Elevated serum calcium levels

Which stage of gout is characterized by the absence of clinical manifestations?

Chronic tophaceous gout

Acute gouty arthritis

Intercritical gout

Asymptomatic hyperuricaemia (correct)

Which joint is most commonly affected during an acute gout attack?

Shoulder joint

MTP joint of the great toe (correct)

Elbow joint

Wrist joint

What are common precipitating factors for gout attacks?

Starvation, dehydration, and alcohol excess Signup and view all the answers

What is a typical clinical feature of gout?

Excruciating pain in the great toe with swelling Signup and view all the answers

What can occur as a chronic complication in patients with gout?

Nodular gout with tophaceous deposits Signup and view all the answers

Which of the following foods is NOT considered a precipitating factor for gout?

Vegetable oils Signup and view all the answers

In which demographic is nodular gout more commonly seen?

Postmenopausal women with kidney impairment Signup and view all the answers

What is the primary method used for diagnosing gout?

Synovial fluid aspiration Signup and view all the answers

Which medication should be avoided during an acute gout attack?

Probenecid Signup and view all the answers

What lifestyle change is NOT recommended for gout prevention?

Increasing alcohol intake Signup and view all the answers

What is the first-line treatment for an acute gout attack?

NSAIDs (except aspirin) Signup and view all the answers

Which of the following dietary changes is advised for gout management?

Limit sugary soft drinks Signup and view all the answers

Under what condition should colchicine be avoided?

In patients with CKD Signup and view all the answers

What is the recommended daily dosage of allopurinol for long-term therapy of gout?

100–300 mg Signup and view all the answers

Which of the following is true about the use of corticosteroids in treating an acute gout attack?

The dosage should be gradually decreased after symptoms improve. Signup and view all the answers

Study Notes

Gout Overview

Gout is a metabolic disorder caused by uric acid buildup (hyperuricaemia).
Urate crystals deposit in joints (acute gouty arthritis), soft tissues (tophi and tenosynovitis), and the urinary tract (urate stones).
Four stages of gout exist: asymptomatic hyperuricemia, acute gouty arthritis, intercritical gout, and chronic tophaceous/gouty arthritis.

Asymptomatic Hyperuricemia

Significantly more common than overt gout (10 times more frequent)
Characterized by elevated serum uric acid levels (>0.42 mmol/L in men, >0.36 mmol/L in women)
Usually without symptoms, often requiring no treatment.

Clinical Features of Gout

Primarily affects men (5-8% prevalence), with earlier onset (40-50) compared to women (60+).
Acute attacks involve excruciating pain, typically affecting the big toe (great toe).
Joint area becomes red, shiny, swollen, hot, and extremely tender.
Symptoms often improve within 3-10 days without treatment or with colchicine, NSAIDs, or corticosteroids.

Causes and Precipitating Factors

Diet: seafood, meat, liver, kidney, high purine foods
Excessive alcohol (binge drinking)
Surgery
Starvation, dehydration, acute illnesses
Medications: frusemide, aspirin, alcohol, cytotoxic drugs, thiazide diuretics
Chronic kidney disease
Myeloproliferative and lymphoproliferative disorders (e.g., leukemia)
Sugary drinks containing fructose
Cytotoxic agents (tumor lysis)
Hypothyroidism
Low-dose aspirin

Gout Arthritis

Monoarthritis (affecting one joint) in about 90% of gout attacks, most commonly the big toe's metatarsophalangeal (MTP) joint (75%).
Can also involve other lower limb joints: toes, midfoot, ankles, and knees.
Polyarthritis (affecting multiple joints) more common in older men, potentially impacting the distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints of fingers.
Affects all synovial joints potentially.

Nodular Gout

Predominantly in postmenopausal women with kidney impairment on diuretic therapy.
Causes pain and tophi around osteoarthritic interphalangeal joints (especially DIP joints) of fingers.

Gout Diagnosis

Synovial fluid aspiration from affected joints, bursae, or tophi to visualize uric acid crystals using polarized microscopy is the definitive diagnostic test.
Elevated serum uric acid levels (though up to 30% are within normal limits during an acute attack).
X-rays may show punched-out erosions at joint margins.

Gout Management - Acute Attack

First-line: Nonsteroidal anti-inflammatory drugs (NSAIDs, except aspirin) in full dosage, taken orally until resolution. Treatment continued for a week after symptoms subside.
Alternative: Corticosteroids (prednisolone 15-30 mg daily) taken orally until symptoms improve, then gradually reduced. Local or intramuscular injections are also possible.
Colchicine: 1 mg orally immediately, followed by 0.5 mg 1 hour later for a single dose (total 1.5 mg) course early to avoid severe kidney dysfunction and prolonged use. Must avoid concomitant use with macrolide antibiotics (e.g clarithromycin), especially in chronic kidney disease.
Principles: Rapid pain relief, prevent further attacks, prevent destructive arthritis, address precipitating factors and comorbidities.

Gout Management - Long-Term

Lifestyle Modifications: Weight loss, healthy diet, avoiding purine-rich foods (organ meats, certain fish, shellfish, game), reducing red meat, processed foods, fried foods, sweets, and alcohol, reducing sugary drink intake, adequate water intake (2 L daily), avoiding diuretics (thiazides, frusemide), and avoiding salicylates/low-dose aspirin. Comfortable shoes to avoid joint pressure. Avoid prolonged fasting.
Medications (prophylaxis): Allopurinol (xanthine oxidase inhibitor) is the first-line choice for frequent attacks, tophi or chronic arthritis, kidney stones. Dose: 100-300 mg daily

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Description

This quiz covers the essential aspects of gout, a metabolic disorder characterized by uric acid buildup. Learn about its stages, clinical features, and how it predominantly affects men. Understand the significance of asymptomatic hyperuricemia and its implications.