Gout

• Multifactoral inheritance pattern
• Most often in men older than 30 years old
• due to either over production or under excretion of uric acid
  • causes of overproduction
    • increased cell turnover (leukemia, treatment for cancer, Lesch-Nyhan syndrome)
  • causes of under excretion
    • lead poisoning, alcoholism

• Clinical
  • Commonly occurs in first toe (podagra)
  • Asymetric joint distribution
  • swollen, red and painful
  • tophus formation
  • acute attacks after alcohol consumption

• Pathology
  • precipitate of monosodium urate crystals into joints
  • crystals are needle shaped and negatively birefringent

• Treatment
  • allopurinol - blocks xanthine oxidase —> d/c production
  • probenecid - increases excretion by inhibiting reabsorption of uric acid
  • colchicine - depolymerizes microtubules impairing chemotaxis and degranulation (d/c inflammation)

http://path.upmc.edu/cases/case205/images/micro9.jpg

http://www.myfootshop.com/images/medical/ortho/gout_labeled.jpg