Gout

*1. What sort of crystals are seen in gout?
2. What is the epidemiology of gout?
3. What is the clinical presentation of gout?
4. What are provocative factors for gout?
5. What are the lab and radiographic findings in gout?
6. What is the treatment for gout?

Answers:
1. Monosodium or sodium urate crystals with negative birefringence.
2. Male >> female, 30-50 years.
3. Exquisite pain in first MTP (podagra), monoarticular, may also be seen in midfoot, ankles, heels, knees. May last days to wks. Tophi form after years of attacks.
4. Trauma, alcohol, drugs (thiazides).
5. Hyperuricemia. Radiograph shows soft tissue swelling around joint, asymmetric, with joint space preserved, no osteopenia.
6. For acute attacks: colchicine inhibits phagocytosis of urate crystals, indocin, corticosteroids. For chronic: allopurinal (decr urate synthesis), probenecid (incr renal excretion of urate).