GOUT

Definition
• Gout is a disorder of purine metabolism which is characterized as
follows:
 Increased serum uric acid concentration
(hyperuricemia).
 Deposition of monosodium urate (MSU)
monohydrate in the leucocytes present in the synovial
fluid.
 Aggregated deposits of monosodium urate monohydrate
(tophi) in and around the joints of the extremities.

• Serum urea levels > 7mg/dl  Hyperuricemia

 Usually begins in the 3rd decade of life. Leucocytes with MSU
 Affects men more than women.
 Etiopathogenesis
Overproduction of uric acid Under excretion of uric acid

Due to Due to

• Enzyme deficiency • Decreased GFR

• Diet – beans, meat, dry beans • Increased tubular reabsorption
• Malignancy • Drug induced hyperuricemia
• Strenuous exercise
• Alcohol, Obesity

Increased levels of uric acid in blood

Uric acid reacts with sodium

Formation of monosodium urate

Deposition in soft tissues, joints, tendons, synovium

 Accumulation of macrophages at the joints

Phagocytosis of urate crystals by macrophages, neutrophils

Release of enzymes, chemical mediators (Interleukins, cytokines)

Tissue injury and inflammation

 Stages of gout
1) Asymptomatic hyperuricemia Puberty in men & after
menopause in women.

2) Acute gouty arthritis After several years; Joint pain, localized

increase in blood supply, warmth

3) Asymptomatic intervals of intercritical periods (Intercritical gout)

Symptom - free period; multiple joints are involved.

4) Chronic tophaceous gout Develops 12 years after the initial

gout attack; Multiple joints are involved & loss of the joint space.
 Signs & Symptoms
• Redness
• Affects lower
Swelling
extremities,
• Intense joint pain fingers, wrist,
elbows
• Tenderness (very soft to touch)
• Joint destruction
• Bone deformity
• Restricted movement
• Stiffness
• Tophus or Tophi Uric acid tophi (hard, uric acid
deposits under the skin) are present and contribute
to bone and cartilage destruction.
• Pseudo gout Deposition of calcium pyrophosphate
in the joint space. Commonly seen in >50 years of
age in both men and women.
• Podagra The joint most commonly involved in gout
is the first metatarsophalangeal joint (the big toe),
and is called podagra.
 References
1) Textbook of Pathology – Harsh Mohan – 8th
edition – Pg no: 897.
2) Basic Pathology – Robbins – First South Asia
edition – Pg no: 823 – 825.
3) https://www.hopkinsarthritis.org/arthritis-inf
o/gout/clinical-presentation-of-gout/