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Gout
- deposition of urate crystals (sodium biurate) in joints, soft tissues,
kidney
- Often begins at 1st metatarsal-phalangeal joint (base of big toe)
- because of reduced solubility of urate at lower temperature of
extremities
- Can accompany hyperuricaemia
- increased consumption
- red wine
- red meat
- body protein breakdown
- reduced excretion
- normal urate levels do not exclude diagnosis
- Uric acid levels can fall after acute attack
- high uric acid level is not diagnostic
- risk of attack increases at high levels of serum urate
- formation of tophi (tophaceous gout)
- smooth white deposits if urate
History
- precipitating factors
- drugs
- aspirin
- diuretics
- allopurinol
- stress
- surgery
- exercise
Examination
- observation
- obesity
- ruddy "boozers" face
- Hands
- nails
- skin
- thin / ulcerated over tophi
- joints
- asymmetrical swelling of small joints
- tophi over joints
- Nerves
- Elbows
- tophi
- subcutaneous yellow / white nodules
- Function
- may be decreased depending on severity
- Extras
Differential Diagnosis
Complications
Investigations
- microscopy
- uric acid crystals needle shaped and negatively birefringent
Treatment
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