Dermatology - Gout

Dermatology - Gout 
Gout is a form of arthritis that is characterized by severe pain, redness, and tenderness in the joints, most commonly affecting the big

Gout is a medical condition characterized by the accumulation of monosodium urate crystals in the synovial fluid and joints. Gout can manifest both with and without hyperuricemia, renal dysfunction, and nephrolithiasis.

Acute gouty arthritis typically manifests in individuals of middle age. Gout often impacts a solitary joint in the lower extremities, commonly the first metatarsophalangeal joint, and may sometimes affect the fingers. Over time, the assaults tend to extend to several joints. Intercritical gout refers to the period of time that occurs between episodes of gout. In cases of chronic tophaceous gout, individuals seldom experience periods without symptoms.


Precise diagnosis relies on the identification of needle-shaped crystals that exhibit birefringence within cells, using polarized microscopy. The histopathologic analysis of a gouty tophus shows the presence of granulomatous inflammation surrounding yellow-brown urate crystals or needle-like spaces arranged in a radial pattern. These spaces indicate the dissolution of crystals throughout the examination process.
Elevated uric acid levels may be detected through laboratory analysis, although it is not essential for diagnosis.
Acute arthritic episodes frequently result in leukocytosis and an increased sedimentation rate.

The objective of therapy for acute attacks is to achieve analgesia and decrease inflammation using nonsteroidal anti-inflammatory medications, colchicine, and corticosteroids. Indomethacin and colchicine have both demonstrated pain-reducing benefits in randomized controlled studies. Colchicine, when administered as 1.2 mg followed by 0.6 mg after 1 hour, has been found to minimize medication interactions and gastrointestinal adverse effects.
Corticosteroids are also considered to be efficacious. Given the frequent presence of several comorbidities in patients, it is imperative to tailor therapy to each individual. Administer medication for a duration of 7 to 10 days following the acute episode, and consider continuing preventive therapy for a period of 3 to 6 months. For individuals who have experienced a single incident, conservative therapy involves avoiding medications that reduce the excretion of uric acid, such as thiazide or loop diuretics, aspirin, pyrazinamide, or niacin. It also includes maintaining proper hydration, achieving weight loss, managing hypertension or hyperlipidemia, and reducing the intake of purine. Uric acid-lowering therapy is recommended for patients with chronic tophaceous gout, renal calculi, significantly elevated serum uric acid levels, high serum uric acid levels in the presence of a known family history of gout (such as a known deficiency of relevant enzymes), or patients undergoing acute chemotherapy. Uricosurics such as probenecid, sulfinpyrazone, and benzbromarone, as well as xanthine oxidase inhibitors like allopurinol and febuxostat, are employed to keep the blood urate level below 6 mg/dL.