Untitled Document

GOUT

Metabolic joint disease
Definition - Deposition of monosodium urate crystals in the joints and periarticular tissues associated with recurrent attacks of acute synovities, and in Late stages with Cartilage degeneration, Renal dysfunction and Uric acid urolithiasis

Sex - Mainly in males

Classification
Primary	Unknown cause

Secondary	secondary to myeloproliferative diseases, renal failures, prolonged use of diuretics

Clinical features	Man around 30yrs
Acute onset	severe joint pain lasting for a week or more may precipitate after minor trauma, operation, unaccustomed exercises or alcohol. Joint involved becomes hot extremely tender.

Joint mainly involved	Metatarso – Phalyngeal joint of the great toe, ankle, finger joints, olecrama bursa

Chronic cases	recurrent acute attacks eventually merges into polyarticular gout. Joints are painful, stiff and deformed. Tophi (while crystals) are seen around the joint, pinna. These white crystals can ulcerate the skin and discharge its chalky material. Renal calculi may also appear.

X-Rays

Acute phase

soft tissue swelling

Chronic phase

Joint space narrowing, secondary Osteoarthritis, punched out cysts or deep erosions in the para articular bone ends.

Treatment

Acute attack

Non-steroidal anti inflammatory, Colchicine Aspiration of a tense joint and local hydrocortisone injection.

Between attacks

Weight reduction, cutting out alcohol, eliminate diuretics
Uricosuric drugs like probenoid or sulfinpyrazone.
Xantine Oxidane inhibitors – Allopurinol.

Late stages

Joint Replacements
Joint fusion.
Joint excision.