Cardinal features of gout
Increase in serum uric acid concentration (>7.0 mg/dL in males and >6.0 mg/dL in females).
Drugs—diuretics, low dose aspirin, pyrazinamide, cyclosporin levodopa
Increased turnover of purine,s
Unidentified inherited defects
The full natural history of gout comprises four stages:
The onset may be insidious or explosively sudden.
Other joints which can get affected include tarsal joints, ankles, knees and wrists. Central joints such as hips, shoulders and spine are seldom affected, possibly because higher temperatures in these joints are not conducive to crystallisation.
Nephropathy is seen in 90% of subjects with gouty arthritis. Two types of parenchymal renal damage have been described:
Serum uric acid levels are elevated. However, during an acute attack, serum uric acid may be normal in 50% cases. 0 Synovial fluid examination by compensated polarised microscopy can demonstrate urate crystals. They are seen as slender, needle-shaped, negatively birefringent structures.
Treatment of acute attack
Drugs for prophylaxis