GOUT AND HYPERURICAEMIA

PSEUDOGOUT (PYROPHOSPHATE
)ARTHROPATHY
Aetiology
Two main types of crystal account for the majority of
crystalinduced arthritis:
GOUT
Hyperuricaemia
Gout is an inflammatory
arthritis associated with
hyperuricaemia and intra-
articular sodium urate crystals.
Epidemiology
The prevalence of gout is increasing mainly in
developed countries approximately 0.2% in Europe
and the USA.
More in MEN than women (10:1).
The prevalence in older females is increasing with
increased diuretic use.
Rarely occurs before young adulthood.
Hyperuricaemia is defined as a
serum uric acid level greater than
two standard deviations from the
mean (420 μmol/L in males, 360
μmol/L in females)
Hyperuricaemia
results from
inadequate renal
excretion of uric acid
relative to its
production and is
the major
determinant for
developing gout.
Pathogenesis
Signs and Symptoms
Any joints can show signs and symptoms of gout,
including:
Pain.
Swelling.
Discolouration.
Numbness or tingling (Pins and needles).
Clinical features
Hyperuricaemia can cause four clinical syndromes:
Investigations
The clinical picture is often diagnostic, as is the rapid
response to NSAIDs or colchicine.
Joint fluid microscopy is the most specific and
diagnostic test but is technically difficult.
Serum uric acid is usually raised (> 600 μmol/L).
If it is not, recheck it several weeks after the attack, as
the level falls immediately after an acute attack.

Serum urea and creatinine are monitored for signs

of renal impairment.
Treatment • indometacin: 75 mg
immediately, then 50 mg
every 6–8 hours. Although
regarded as the ‘gold
standard’ treatment by
some, the frequency of
side-effects is unacceptably
high with indometacin.
• naproxen
• diclofenac
Caution: NSAIDs may cause renal impairment
In individuals with
renal impairment
or a history of
peptic
ulceration,alternati
ve treatments
:include
Chronic tophaceous gout
• In chronic tophaceous gout,
sodium urate forms smooth
white deposits (tophi) in skin
and around joints. They occur
on the ear, the fingers or the
Achilles tendon.
• Large deposits are unsightly
and ulcerate.
• There is chronic joint pain and
sometimes superimposed acute
gouty attacks.
• Tophaceous gout is often
associated with renal
impairment and/or the long-
term use of diuretics.
On X-ray
Periarticular deposits
lead to a halo of
radio-opacity and
clearly defined
(‘punched out’) bone
.cysts on X-ray
Calcium pyrophosphate deposits in hyaline
and fibrocartilage produce the radiological
appearance of chondrocalcinosis.
Shedding of crystals into a joint
precipitates acute synovitis which
resembles gout.

How to differentiate??
In young people it may be associated
with haemochromatosis,
hyperparathyroidism, Wilson’s disease
or alkaptonuria.
Diagnosis
Treatment