Gout in MRCP

GOUT IN MRCP

I saw this patient during my clinic follow up recently, so I am going to discuss with you about gout today. Gout is commoner than you think. Gout is due to deposition of uric acid crystals in joints. Certain joints are commonly involved such as first toe, ankle and small joints of hands.


Chronic tophaceous gout with tophi!

Clinical Presentations

There are a few possible manifestations of gout. These are,
a) asymptomatic hyperuricemia
b) acute arthritis
c) chronic arthritis
d) chronic tophaceous gout

Physical signs

You may find swollen and tender joint if patient has acute arthritis, you must always consider septic arthritis as your differential diagnosis. Patient may also present to you with chronic tophaceous gout as I have shown you as the images above.

Precipitating Factors for Acute Attack

There are a few precipitating factors for you to get acute attack of gout. These factors are,
a) Trauma
b) Drugs such as diuretics, aspirin ( always a popular question in MRCP, remember hat only low dose of aspirin precipitates gout)
c) Copious consumption of alcohol
d) Dehydration
e) Surgery
f) Infection
g) Food high in Purines
h) Induction chemotherapy for certain cancers such as leukemia

Treatment

Pharmacological and non-pharmacological treatments are available.
a) Diet and lifestyle changes
b) Drugs such as Allupurinol, Probenecid. Remember that allupurinol interacts with Azathioprine and cyclophosphamide and increases the toxicity of these cytotoxic drugs ( VERY popular question in MRCP!)

Gout Vs Pseudogout

Remember that pseudogout is acute arthritis resulting from the release of calcium pyrophosphate ( deposited in the bone and cartilage) into the synovial fluid.
Gout /Pseudogout

More severe and short lasting / less severe and longer lasting
Usually first toe involved/ mainly the knee
Negatively birefringent/ Positive
Needle shape crystal / Rhamboishape
No calcium deposition / Ca deposition on X ray

Tips for MRCP

1) Remember that allupurinol also can cause Steven Johnson syndrome!
2) Related post, click here!