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Gout - a guide for the general and acute physicians - PubMed

Review

Gout - a guide for the general and acute physicians

Abhishek Abhishek et al. Clin Med (Lond). 2017 Feb.

Abstract

Gout is the most prevalent inflammatory arthritis and affects 2.5% of the general population in the UK. It is also the only arthritis that has the potential to be cured with safe, inexpensive and well tolerated urate-lowering treatments, which reduce serum uric acid by either inhibiting xanthine oxidase - eg allopurinol, febuxostat - or by increasing the renal excretion of uric acid. Of these, xanthine oxidase inhibitors are used first line and are effective in 'curing' gout in the vast majority of patients. Gout can be diagnosed on clinical grounds in those with typical podagra. However, in those with involvement of other joints, joint aspiration is recommended to demonstrate monosodium urate crystals and exclude other causes of acute arthritis, such as septic arthritis. However, a clinical diagnosis of gout can be made if joint aspiration is not feasible. This review summarises the current understanding of the pathophysiology, clinical presentation, investigations and treatment of gout.

Keywords: colchicine; gout; hyperuricemia; tophi; urate-lowering treatment.

© Royal College of Physicians 2017. All rights reserved.

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Figures

Fig 1.
Fig 1.

Urate transport in the kidney. A – mechanism of reabsorption of uric acid; B – mechanism of uric acid secretion. Differences in the activity of these urate transporters result in hyperuricaemia.

Fig 2.
Fig 2.

Polarised light microscopy showing needle shaped negatively birefringent (change in colour of the MSU crystal on employing the polariser) monosodium urate crystal. Figure courtesy of the Department of Microbiology, Addenbrookes Hospital, Cambridge, UK.

Fig 3.
Fig 3.

Radiographs showing changes of gout. A – soft-tissue swelling around the index and little finger proximal interphalangeal joints in a patient with tophaceous gout; B – erosion in the first metatarsophalangeal joint with overhanging edges; C – typical punched out erosions in the first metatarsophalangeal joint with sclerosis and preserved bone mineral density (c.f. in rheumatoid arthritis the bones appear osteopaenic).

Fig 4.
Fig 4.

Ultrasound scan of the first metatarsophalangeal joint showing double contour sign (solid white arrow) and tophus (dashed white arrow) in the dorsal synovial recess.

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