Clinical features of Gout include:

Answer is D (All of the above):1present with all of the features mentioned as options in the above question.GoutA disorder of purine metabolism characterized by hyperuricaemia, deposition of mono - sodium urate- monohydrate crystals in joints and per-aicular tissuese and recurrent attacks of acute synovitis. Late changes include cailage degeneration, renal dysfunction & uric acid ttrolithiasisEpidemiologyPathologyClinical FeatureTreatment* Commoner in Caucasians* More wide spread in men thanin womendeg (may be 20 :1)Usually men over the age of 30yearse; women are seldomaffected until after menopause.Often there is a family history.TophiAcute attack is sudden onset ofsevere joint pain that lasts for aweek or two. Usually comes out ofblue but may be precipitated by-minor trauma- illness- unaccustomed exerciseAntiinflammatory * Tophi arenodular depositsof monosodiumuratemonohydratecrystals, with an* Mainstay oftreatment duringacute attack isadministration ofantinflammatorydrug such ascokhicine, NSA* Sterotype patient is obese,rubicund, hypeensive and fondassociatedforeign body- alcohol(except aspirin) orof alcohol and may be nudgedreaction. It is- ACTCHglucocoicoidsQinto an attack by uncontrolleddeposited in- steroid withdrawl* Glucocoicoids mayadministration of diuretics oraspirindegminute clumpsin connective- hypouricemic therapy, drugsbe used.* Common in Hypercurecemicpatients* The rate of urate deposition injoint and aicular destructioncorrelate with the duration andseverity of hyperuricemia. Thecomplications of gout correlatetissue eg.- aicular cailage'- tendon (not muscle)''-(pyri mol), MI, stroke- The commonest sites aremetatarsophalangeal joint of bigtoe'' > ankle & finger joints andolecranon bursae.- The skin is red, shiny, swollen,hot and extremely tender1Hypourecemics* Probenecid or sulfinpyrazone can beused if renalfunction is normal.Xanthine oxidaseinhibitorswith both duration & severity of- periaicularsuggesting a cellulitis or septic hyperuriacemiatissueahritis* Allopurinol, axanthine oxidase- Although the risk of developing clinical features of gout increases with increasing levels of serum uric acid, only a fraction of those with hyper- synovium & joints_ pinnae (cailage) of earInvestigationsinhibitor is usuallypreferred.These drugs shouldnever be staed in**Characteristic negativelybirefringent monosodium uratecrystals in the synol fluiduricaemia develop symptoms- ligamentsexamined by polarizingacute attack, and- Any factor that causes either an abrupt increase or decrease in the serum urate levels may- aicular ends of bone- subcutaneouse.microscopy is diagnostic* X- rays show only soft tissueswelling. Chronic gout may resultthey should always be covered by an anti inflammatoryprovoke an acute attack, thehest correlations being factorstissue'_ kidneyin joint space narrowing & ry seconda OApreperations or colchic colchicine; otherwise they maythat cause an abrupt fall'. * Tophi appear as characteristicactually precipitateSerum uric acid levels can benormal or low at the time ofacute attacke- Despite these limitations, serumuric acid is almost alwayselevated at some timee and canbe used to follow the cource ofhypouricemic therapy.* Tophi mayulcerate throughh throskin or destroycailage &periaicularbonepunched out cysts or deeperosions with over hanging bonyedgesQ(Maers G' or G sign).These well defined erosions arelarger & slightly fuher from jointmargin than typical RA erosions.an acute attack''. Inchronic tophaceousgout and in allpatients with renalcomplications,allopurinol is drugof choice'.