Gout

Gout is the most common cause of inflammatory arthritis in men over the age of 40 years with an overall incidence of about 1.4/1000 per annum and an overall prevalence of more than 1% in UK General Practices. Gout results from the deposition of microcrystals of monosodium urate from hyperuricaemic body fluids. Although the risk of developing gout increases with the level of serum urate, there are ten times as many people in the community with asymptomatic hyperuricaemia. The incidence and prevalence of gout have doubled in the last 40 years. 75% of patients with gout have features of the metabolic syndrome (central obesity, hypertension, hyperglycaemia, hypertriglyceridaemia and low HDL) and recent epidemiological studies have confirmed that alcohol consumption (especially beer) and diets high in red meat and shell fish are risk factors for the development of gout while diets rich in dairy products are protective. The pathophysiology of gout and hyperuricaemia are briefly described. The primary and secondary causes of increased urate production and reduced renal excretion of uric acid that can lead to gout are summarized, and the clinical features, diagnosis and differential diagnosis of gout are described. Acute gout can be effectively treated with non-steroidal anti inflammatory drugs, colchicine or intra-articular corticosteroids and recurrent episodes can be prevented with the uricostatic xanthine oxidase inhibitor allopurinol or uricosuric drugs.