Education And Debate


BMJ 1995; 310 doi: (Published 25 February 1995) Cite this as: BMJ 1995;310:521
  1. Michael L Snaith

    The term gout is sometimes loosely used to describe an acutely painful foot, but it is best reserved for those cases where deposition of crystals of uric acid (urate) is thought to be the cause of pain. The big toe (first metatarsophalangeal) joint is the classic site for urate gout, and an overweight, overindulgent man is the traditional sufferer. However, a substantial minority of patients (perhaps 30%) first get their gout at another site (such as other parts of the foot, the knee, the hand, or the shoulder), and, with more older women in the population and the widespread use of diuretics (which raise blood urate concentrations), this traditional view needs revising.

    Classic podagra: acute gouty arthritis of first metatarsophalangeal joint.

    Chronic, relatively painless, tophaceous gouty arthritis of fingers, probably due to patient's long term treatment with diuretics.

    Acute gouty olecranon bursa. This, the patient's first attack of gout for many years, occurred after major bowel surgery.

    Gout is a condition of occasional attacks and long periods of remission. The prevalence of people at risk is therefore quite different from the incidence of actual attacks: a general practice with a list of 2000 patients might have 15 men and 3 women with a tendency to gout. Although most such patients are managed in primary care, acute gout may be precipitated by diuretics or by stresses such as acute infection, ketosis, or surgery, and cases therefore also crop up in hospital.

    Chronic gouty arthritis is not common but can still be found, even though in most cases it can be treated and prevented. The x ray appearance is characteristic and should not be confused with other forms of arthritis. Tophi develop mainly in the ear but also occur elsewhere.

    Hands of patient with chronic gouty arthritis (top) and his radiographs (bottom). …

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