Clinical features of Gout include:
Answer is D (All of the above):1present with all of the features mentioned as options in the above question.GoutA disorder of purine metabolism characterized by hyperuricaemia, deposition of mono - sodium urate- monohydrate crystals in joints and per-aicular tissuese and recurrent attacks of acute synovitis. Late changes include cailage degeneration, renal dysfunction & uric acid ttrolithiasisEpidemiologyPathologyClinical FeatureTreatment* Commoner in Caucasians* More wide spread in men thanin womendeg (may be 20 :1)Usually men over the age of 30yearse; women are seldomaffected until after menopause.Often there is a family history.TophiAcute attack is sudden onset ofsevere joint pain that lasts for aweek or two. Usually comes out ofblue but may be precipitated by-minor trauma- illness- unaccustomed exerciseAntiinflammatory * Tophi arenodular depositsof monosodiumuratemonohydratecrystals, with an* Mainstay oftreatment duringacute attack isadministration ofantinflammatorydrug such ascokhicine, NSA* Sterotype patient is obese,rubicund, hypeensive and fondassociatedforeign body- alcohol(except aspirin) orof alcohol and may be nudgedreaction. It is- ACTCHglucocoicoidsQinto an attack by uncontrolleddeposited in- steroid withdrawl* Glucocoicoids mayadministration of diuretics oraspirindegminute clumpsin connective- hypouricemic therapy, drugsbe used.* Common in Hypercurecemicpatients* The rate of urate deposition injoint and aicular destructioncorrelate with the duration andseverity of hyperuricemia. Thecomplications of gout correlatetissue eg.- aicular cailage'- tendon (not muscle)''-(pyri mol), MI, stroke- The commonest sites aremetatarsophalangeal joint of bigtoe'' > ankle & finger joints andolecranon bursae.- The skin is red, shiny, swollen,hot and extremely tender1Hypourecemics* Probenecid or sulfinpyrazone can beused if renalfunction is normal.Xanthine oxidaseinhibitorswith both duration & severity of- periaicularsuggesting a cellulitis or septic hyperuriacemiatissueahritis* Allopurinol, axanthine oxidase- Although the risk of developing clinical features of gout increases with increasing levels of serum uric acid, only a fraction of those with hyper- synovium & joints_ pinnae (cailage) of earInvestigationsinhibitor is usuallypreferred.These drugs shouldnever be staed in**Characteristic negativelybirefringent monosodium uratecrystals in the synol fluiduricaemia develop symptoms- ligamentsexamined by polarizingacute attack, and- Any factor that causes either an abrupt increase or decrease in the serum urate levels may- aicular ends of bone- subcutaneouse.microscopy is diagnostic* X- rays show only soft tissueswelling. Chronic gout may resultthey should always be covered by an anti inflammatoryprovoke an acute attack, thehest correlations being factorstissue'_ kidneyin joint space narrowing & ry seconda OApreperations or colchic colchicine; otherwise they maythat cause an abrupt fall'. * Tophi appear as characteristicactually precipitateSerum uric acid levels can benormal or low at the time ofacute attacke- Despite these limitations, serumuric acid is almost alwayselevated at some timee and canbe used to follow the cource ofhypouricemic therapy.* Tophi mayulcerate throughh throskin or destroycailage &periaicularbonepunched out cysts or deeperosions with over hanging bonyedgesQ(Maers G' or G sign).These well defined erosions arelarger & slightly fuher from jointmargin than typical RA erosions.an acute attack''. Inchronic tophaceousgout and in allpatients with renalcomplications,allopurinol is drugof choice'.
Severe joint pain
Involvement of small joints
Deposition of monosodium urate crystals in syynovium
All of the above