Gout: Arthropathies

SYMPTOMS

There is a gradual or acute dramatic onset of effusion and often severe pain in the knee, without preceding trauma. This condition can affect virtually any joint but is common in the knee.

AETIOLOGY

This is one of many types of arthropathies that can affect the joints and is often mistaken for an orthopaedic injury. A minor trauma can trigger an attack. Gout is caused by excessive outflow of uric acid, due to a metabolic imbalance. It was formerly called ‘port wine toe’ since it is most known for the dramatic red swelling in MTP I and correlated with alcohol intake.

CLINICAL FINDINGS

There is painful, often massive, effusion and increased temperature of the knee.

INVESTIGATIONS

X-ray can exclude fractures, OCD, osteoarthritis, other osteochondral injuries and bone tumours. MRI can exclude soft tissue tumours and other localised soft tissue lesions. Serum levels of uric acid are elevated (more than 400) in most cases.

TREATMENT

Nutritional advice is sometimes helpful, since these attacks are sometimes triggered by intake of specific food or drinks. Arthroscopic partial synovectomy is sometimes helpful in severe and chronic cases with mechanical block in movement. However, in many cases medication with NSAID for recurrent attacks and regular medication with Alopurinol for prevention of further attacks is required.

REFERRALS

These patients are usually referred to their GP or a rheumatologist.

EXERCISE PRESCRIPTION

Cycling and water exercises are good alternatives to keep up general fitness.

EVALUATION OF TREATMENT OUTCOMES

Normal clinical symptoms and signs.

DIFFERENTIAL DIAGNOSES

A variety of arthropathies, reactive arthritis, early stages of septic arthritis, PVNS etc.

PROGNOSIS

This is one of many conditions, which can cause deterioration of the affected joint.