Gout

(MSU gout)

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 Definition
• Metabolic disease most often affecting
middle-aged to elderly men.

• It is typically associated with an increased

uric acid pool, hyperuricemia, episodic
acute and chronic arthritis, and deposition
of MSU crystals in connective tissue tophi
and kidneys.

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 Acute and chronic arthritis
• Acute arthritis is the most frequent early
clinical manifestation of MSU gout.

• Usually, only one joint is affected initially.

• Metatarsophalangeal joint of the first toe+++

• First episode at night : pain, swelling, warm,

red, and tender (mimics a cellulitis).
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• Several events may precipitate acute gout
arthritis
- Dietary excess,
- Trauma,
- Surgery,
- Excessive ethanol ingestion,
- Adrenocorticotrophic hormone (ACTH) and
glucocorticoid withdrawal,
- Hypouricemic therapy,
- Serious medical illness (myocardial infarction,
stroke).

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• Strong family history of gout, renal
insufficiency, hypertension, diuretics.

• Underlying degenerative joint disease

and inflamed tophaceous deposits.

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 Laboratory diagnosis

• Urate crystals (synovial fluid),

• Elevated serum uric acid,

• Urea nitrigen, creatinine, white blood cell

count, serum lipids.

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 Treatment
• Acute gouty arthritis
Anti-inflammatory drugs
- Colchicine,
- NSAIDs,
- Glucocorticoids.

• Hypouricemic therapy
- Risk factors : diuretic use…
- Uricosuric agents : probenecid,
- Hypouricemic drugs : allopurinol.
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