Investigating gout: taking a new approach to an old disease

Abstract

Gout is a very painful and common form of acute arthritis, which is becoming increasingly prevalent in many Western societies. Gout was first identified by the Egyptians and is caused by a disorder of the body’s purine metabolism, resulting in raised serum uric acid level, known as hyperuricaemia. Gout tends to affect the older population, particularly obese patients and others with rather negative lifestyle habits, such as a high alcohol intake. However, in the majority of patients suffering from idiopathic gout (75–90%) the evidence suggests that these patients may actually have a genetic disposition to the reduced renal excretion of urate acid. Gout has a rapid onset and the most commonly affected joint is the first metatarsophalangeal, although other joints can also be affected such as the mid-foot, ankle, knee, wrist, finger and elbow. Recommended gout treatment includes non-steroidal anti-inflammatory drugs, colchicine and corticosteroids. Preventative treatments include allopurinol, which aims to lower uric acid levels. The definitive diagnostic test for gout is the aspiration of the joint or tophus and the confirmed identification of monosodium urate crystals. The presence of urate crystals confirms a diagnosis of gout and the absence of evidence of infection will rule out the key differential diagnosis of septic arthritis.