2567. Explanation
Correct Answer: B) Synovial Fluid
Analysis
Explanation:
Acute gout can be diagnosed with certainty by identifying urate crystals in synovial fluid, bursa or aspirate of tophus. In acute gout synovial fluid is highly inflammatory, with white blood cell counts of ≥2,000 cells/mm3.
Even when uric acid crystals are seen, the joint fluid should also be examined for the simultaneous presence of other crystals, especially calcium pyrophosphate crystals, and should undergo Gram stain and culture to rule out co-infection.
Gout
Inflammatory arthritis caused by the deposition of monosodium urate crystals in joints and tissues due to hyperuricemia
Clinical Presentation:
Acute Gouty Attack- Sudden onset of intense joint pain, typically affecting the big toe, but can also involve other joints such as the ankle, knee, wrist, or elbow
Chronic Gout- Recurrent attacks of joint inflammation, development of tophi (deposits of urate crystals) in joints and soft tissues
Diagnosis:
Medical History- History of recurrent joint pain, sudden onset, and self-limiting nature of attacks.
Physical Examination- Joint examination revealing signs of inflammation (redness, swelling, warmth)
Synovial Fluid Analysis-Detection of monosodium urate crystals in synovial fluid aspirated from an affected joint.
Serum Uric Acid Level- Elevated serum uric acid levels (>6.8 mg/dL) may support the diagnosis, but levels can be normal during an acute attack. Repeated estimations of serum uric acid levels is of great value.
Treatment:
Acute Attack- Nonsteroidal anti-
inflammatory drugs (NSAIDs), colchicine, corticosteroids for pain relief and inflammation control
Long-term Management-
Lifestyle modifications (dietary changes, weight loss), medications to lower uric acid levels (allopurinol, febuxostat) to prevent further attacks.
Serum Uric Acid Level (Option A):
Serum uric acid levels are often normal during an attack of acute gout, repeated estimations of serum uric acid levels is helpful.
Urine Uric Acid Levels (Option C):
Urine uric acid levels are not typically used as a diagnostic test for gout.
Although increased urinary excretion of uric acid may be observed in some cases of gout, it is not a specific or reliable marker for diagnosing the condition.
X-Ray Changes (Option D): X-ray changes, such as the presence of joint erosions or bone damage, may occur in advanced stages of gout (chronic gout) or if there have been recurrent episodes of inflammation over time.
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