Symptoms: Painful joint- arthritis. Later polyarthritis; ethanol (alcohol abuse; involvement of metatarsophalangeal joint of first toe; may also affect tarsal, ankle and knee joints as well as finger joints. Joint pain and swelling at night
Special signs: Heberden's nodes; Bouchard's nodes; acute arthritis. May be associated with one or more of the following- bursitis, tendinitis, enthesitis, synovial osteochondromatosis, destructive arthropathies, tendon rupture; tophaceous deposits.
Special investigations: Monosodium urate crystals in inflammed joints or tophaceous deposits which are strongly birefringent (polarising microscope) and needle shaped; Synovial fluid cell count to 60,0000/µL; cloudy effusion with leukocytes; elevated serum uric cid; elevated 24 hr uric acid in urine.

Associated with other crystal arthropathies which may produce calcium pyrphosphate dihydrate (CPPD), calcium hydroxyapatite (HA), and calcium oxalate (CaOx). These are related to the following conditions- certain types of osteroarthritis, pseudo -rheumatoid arthritis, pseudo-ankylosing spondylitis, spinal stenosis, Crown dens syndrome and carpal tunnel syndrome.

Gout is a metabolic disease which is inherited as multifactoral disease. Gout can be divided into two broad categories- primary and secondary gout.

In primary gout (the familial types) there are about 2 types – idiopathic and adult primary gout in which the basic biochemical defect could be their overproduction or under excretion of uric acid. Other types include gout itself being associated with some specific protein defects such as von Gierke’s disease, or association with cerebral palsy, Lesch-Nyhan syndrome, uric aciduria and tophaceous gout. Secondary gout which is not inheritable may arise as a result of other underlying diseases such as haematological disorders, chronic renal disease, essential hypertension and ingestion of hyperuricacidemogenic agents.




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