Fri 30th Aug 2013
Session 2 / Talk 5
11:25 – 11:35
A short presentation on Gouty arthritis, to help further our understanding of a
common indication seen on Xray requests. In our presentation we are going to
cover the basics of Gout, including a definition, pathological classification, history
and nature of this joint pathology, and also clinical management of patients
suffering from Gout.
Gout is a type of arthritis that results from an inflammatory response to a build up of
uric acid in the vascular system progressing to erosion of the articulating surfaces
of bones. It is an inherited metabolic disease and is classed either as an acute or
chronic condition.
Gout is more prevalent in males and can be influenced by diet and lifestyle. The
pathogenesis of Gout involves the metabolism of Purines, a type of nucleic acid
found in beer, fish, and mushrooms. This results in a waste product called Uric
acid, which if not regulated by the Kidney, will crystallize and lead to bone erosion.
Clinicians suspecting Gouty arthritis in their patient are likely to consider the
patient’s history, and send for tests such as Xray or synovial joint aspirations.
 Definition of Gout
 Pathological classification
 History of Gout
 Gout Aetiology & Pathogenesis
 Clinical management of Gout patients
 Gout is a type of arthritis
 Gout results from an inflammatory response
to build up of Uric acid in blood
 Progresses to Urate crystals in joints
 Urate crystals erode articulating surfaces of
 An inherited metabolic disease
 Acute of Chronic
Sudden Onset
Recurring problem
Short term symptoms
Insufficient resolution
between attacks
Can resolve without
Can progress to chronic
Cartilage/bone destruction
 Acute Gout
 Chronic Gout
Discovered in 2640 BC by Egyptians
460-370 BC Hippocrates described Gout as an
acute inflammation of 1st MTP joint
129-200 AD Galen described Tophi. Galen
recognised hereditary nature of Gout
 More likely to
suffer Gout
 Most often affects
 Less likely to
suffer Gout
 Gout appears as radiolucent bone erosions
around joints
 Soft tissue swelling and inflammation present
 Gout results from a build up of Uric acid
 Uric acid results from metabolism of Purines
 High blood uric acid levels can be due to a
Purine-rich diet or kidney insufficiency
 The nephron
 Higher incidence of Gout in males as
Oestrogen assists renal clearance of uric acid
 Excess uric acid levels decrease
 This leads to crystalization
 Urate deposits are covered with
proteins as part of immune
response forming Tophi
 Tophi are the cause of bone
 Treatment is in two stages
 Minimization of the acute inflammation
 Prevention of future attacks
• Acute attacks are managed with drugs. They
last 1-2 weeks
• Chronic conditions are treated by lowering
uric acid levels through exercise, weight loss,
diet changes
 Patient history & physical examination
 Arthrocentesis test
 Blood/Urine analysis
 X-ray studies
Focus will be on
 Family history
 Recent trauma
 Patient’s lifestyle & diet
 Test involves aspirating synovial fluid from
affected joint
 Fluid is examined for urate crystals
 Performed when diagnosing chronic Gout
 Performed to assess uric acid levels when
Gout diagnosis is unclear
 Performed mainly in later stages of Gout
 Patient had pain, swelling, deformities of 1st
MTP joints.
 Swelling around 3rd MCP joint in both hands
 MRT contact with Gout patients is usually in
later stages of disease
 Be mindful positioning as the patient may be
in pain
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Dalbeth, N. (2006). The Pathway from Gout to Bone Erosion. Retrieved from
Doherty, M. (2009). New Insights into the Epidemiology of Gout. Oxford Rheumatology Journal, 48:ii2–ii8. doi:10.1093
Eustice, C. (2012). Cut Back Purine-Rich Foods with Gout. Retrieved from
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Gout: Exams and Tests. (2010). Retrieved from http://arthritis.webmd.com/tc/gout-exams-and-tests
Kowalczyk, N., Mace, J. (2009). Radiographic Pathology for Technologists (5th ed.) St. Louis, Missouri: Mosby Elsevier
Mandell, B. (2008). Clincal Manifestations of Hyperuricemia and Gout. Cleveland Clinical Journal of Medicine, 75(5).
Retrieved from http://ccjm.org/content/75/Suppl_5/S5.full.pdf
Manno, R. (2012). Clinical Features of Gout. Retrieved from http://www.hopkinsarthritis.org/arthritis-info/gout/clinicalpresentation-of-gout/
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Research and Therapy 2006, 8(1), doi:10.1186/ar1906
Stoppler, M. (2012). Gout. Retrieved from http://www.medicinenet.com/gout/page2.htm
Taylor, K. (2012). Uric Acid Crystals. Retrieved from http://www.goutpal.com/uric-acid/uric-acid-crystals/
Teitel, A. (2011). Gout. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001459/
Zare, F., Magnusson, M., Bregstrom, T., Brisslert, M., Josefsson, E., Karlsson, A., Tarkowski, A. (2006). Uric Acid, a
nucleic acid degredation product, down-regulates dsRNA-triggered arthritis. Journal of Leukocyte Biology, 79(3), 4824. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16387838
Rouse Educational
Pauline Hext

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