BOF: 24
A 45-year-old male presents with a sudden onset of pain
and swelling of the metatarso-phalangeal joint of the right big toe.
In this patient
a)
A normal serum uric acid concentration excludes the diagnosis of gout
b)
The x-ray changes would be characteristic
c)
Synovial fluid analysis should be delayed to allow crystals to aggregate
and become easier to visualise
d)
Fever, leucocytosis and elevated ESR would suggest septic arthritis
e)
The first attack is seldom associated with residual disability
Answer:
e)
In an acute attack of gout serum uric acid is raised in
only about 60 % of patients. Similar x-ray changes may occur in inflammatory and
degenerative arthritis. Synovial fluid analysis should be undertaken immediately
following aspiration of joint fluid. The characteristic changes being the demonstration of needle
shaped negatively birefringent crystals of mono-sodium urate in synovial fluid
neutrophils by polarizing light microscopy. A raised ESR fever and leucocytosis
can accompany very acute attacks of gout and do not necessarily indicate sepsis.
The first attack of gout is seldom associated with residual disability.
