1
Sunday, 16th January 2022
Week 1
Medicine
The Pathophysiology of Joint Disease 3
Gout (crystal arthritis)
Patient
Guy
o 35
o Male
History
o Woke with acute pain in left ankle and pig toe
o Unable to go back to sleep
o Unable to walk
o Previous similar episodes
Examination
o Internal swelling around the ankle and great toe MTP
o Extends to mid foot
o Redness
o Felt very warm
o Examined all joints and systemic investigation
Over right thumb had hard swelling
Nodular
Creamy and pearly under the skin
Slowly worsening over the last 12-18 months
Discharges chalky toothpaste like substance
Tests
o FBC, U&E - Normal
o CRP – 85 – significantly raised
o Urate – 568 – significantly raised
o RF, CCP ANA – negative
Diagnosis
o Characteristic presentation of Gout
o Uric acid crystals around thumb – acute or chronic gout
Crystal arthritis
Gout
o uric acid crystals
Calcium phosphate disease
o CPPD crystals
Irritative
Acute inflammatory reaction around joints
Acute onset
Self-limiting episodes of joint inflammation
Chronic damage
Gout
Epidemiology
Common
1-2% adults
More common in men
, 2
Sunday, 16th January 2022
Week 1
Medicine
o 4:1 m:f
Most common cause of inflammatory arthritis in men
Increases with age
Comorbidities are common in gout patients
Renal impairment
Coronary heart disease
Metabolic syndromes
o Obesity
o Dyslipidaemia
o Hypertension
o Diabetes (type 2)
Important to consider in patients with gout
May restrict therapeutic options
Risk factors in gout
Non-modifiable
o Age
o Sex
Women protected during menstruating years
Less protection after menopause
o Race
o Genetic factors
Family clusters
Not understood why
o Impaired renal function
Modifiable
o Hyperuricemia
o High-purine diet
o Alcohol consumption
o Obesity
o Medications
Hyperuricemia
Demonstrated that the higher levels of uric acid lead to gout
Purine rich foods
Seafood
Red meat
Associated with elevated risk of gout
Dairy products 4% reduction
Vegetables made little difference
Men who consume 2 or more sugary soft drinks have an 85% higher change of
getting gout
Alcohol intake
Varies according to alcohol consumed
Those that drank beer have a higher risk of gout compared to those who drank
spirits or wine
Wine made little difference
Sunday, 16th January 2022
Week 1
Medicine
The Pathophysiology of Joint Disease 3
Gout (crystal arthritis)
Patient
Guy
o 35
o Male
History
o Woke with acute pain in left ankle and pig toe
o Unable to go back to sleep
o Unable to walk
o Previous similar episodes
Examination
o Internal swelling around the ankle and great toe MTP
o Extends to mid foot
o Redness
o Felt very warm
o Examined all joints and systemic investigation
Over right thumb had hard swelling
Nodular
Creamy and pearly under the skin
Slowly worsening over the last 12-18 months
Discharges chalky toothpaste like substance
Tests
o FBC, U&E - Normal
o CRP – 85 – significantly raised
o Urate – 568 – significantly raised
o RF, CCP ANA – negative
Diagnosis
o Characteristic presentation of Gout
o Uric acid crystals around thumb – acute or chronic gout
Crystal arthritis
Gout
o uric acid crystals
Calcium phosphate disease
o CPPD crystals
Irritative
Acute inflammatory reaction around joints
Acute onset
Self-limiting episodes of joint inflammation
Chronic damage
Gout
Epidemiology
Common
1-2% adults
More common in men
, 2
Sunday, 16th January 2022
Week 1
Medicine
o 4:1 m:f
Most common cause of inflammatory arthritis in men
Increases with age
Comorbidities are common in gout patients
Renal impairment
Coronary heart disease
Metabolic syndromes
o Obesity
o Dyslipidaemia
o Hypertension
o Diabetes (type 2)
Important to consider in patients with gout
May restrict therapeutic options
Risk factors in gout
Non-modifiable
o Age
o Sex
Women protected during menstruating years
Less protection after menopause
o Race
o Genetic factors
Family clusters
Not understood why
o Impaired renal function
Modifiable
o Hyperuricemia
o High-purine diet
o Alcohol consumption
o Obesity
o Medications
Hyperuricemia
Demonstrated that the higher levels of uric acid lead to gout
Purine rich foods
Seafood
Red meat
Associated with elevated risk of gout
Dairy products 4% reduction
Vegetables made little difference
Men who consume 2 or more sugary soft drinks have an 85% higher change of
getting gout
Alcohol intake
Varies according to alcohol consumed
Those that drank beer have a higher risk of gout compared to those who drank
spirits or wine
Wine made little difference
