Gout and Pseudogout

Gout is caused by a deposit of sodium urate crystals in the joint and may be excruciatingly painful. It is often as a result of high uric acid levels in the blood but may be present despite normal uric acid levels.

This disease usually affects middle-aged men (40-60 years), and presentation is usually in the small joints of the fingers. They are usually swollen, red and warm and may be difficult to differentiate from an infection. In more chronic cases nodules or ‘tophi’ form, with whiteish toothpaste like substance sometimes discharging from them.

  • Management

Non-operative management is the mainstay of treatment, with anti-inflammatories and specific urate lowering medication, coupled with diet modifications as there are often precipitant foods or drinks that trigger it. Surgical management is indicated if the joint is degenerate and causing pain, or if the nodules are becoming infected.

Pseudogout presents very similarly to gout, but the crystal that causes the symptoms is calcium-pyrophosphate. They precipitate out in the joint and cause pain and swelling, most often in older men and more commonly in the wrist than in the finger joints. The diagnosis is often made at surgery by arthroscopic biopsies when infection in the wrist (or other joints) is suspected. The treatment is usually non-operative with rest and anti-inflammatories.

Conditions Managed

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