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Pathology
Increased levels of monosodium urate monohydrate (MSU) crystals.
Uric acid is an end product of purine metabolism excreted by the kidneys
Aetiology
Thiazide diuretics, Increased dietary purine intake, renal failure, lead, inherited enzyme deficiency, dehydration, low-dose aspirin
Signs
Tophi on hands, pinna, polyarthritis
Symptoms
Monoarthritis, painful, swollen, hot, erythematous joint for 7-14 days
Pain and inflammation in the metatarsal-phalangeal joint of the great toe is highly suggestive of acute gout
Investigations
Bloods: Uric Acid levels
Joint aspirate: Negatively Birefringent Needle-shaped crystals
Imaging: X-Rays show cortical erosions and marginal sclerosis
Treatment
Acute: NSAIDs or colchicine, corticosteroids are used if renal function impaired
Prophylaxis Allopurinol (xanthine oxidase inhibitors - guidelines state initiate 2
weeks after an acute episode
Conservative: Avoid high-purine foods and alcohol
Prognosis
Destructive changes like osteoarthritis
Degenerative arthritis, uric acid nephropathy and renal stones, nerve or spinal cord impingement, increased susceptibility to infection
Key Facts
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Key References
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