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.

 
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