Gout and hyperuricaemia are often associated with obesity, type IV hyperlipoproteinaemia, impaired glucose tolerance, hypertension and ischaemic heart disease. Pathology Prolonged hyperuricaemia leads to the formation of small crystal aggregates. These accumulate in the synovium and at external sites, such as the eari, cartilage and olecranon, and may eventually become visible tophi. Crystal deposition may proceed over several years without symptoms. Uric acid and urate deposition in the kidneys can lead to renal stones.
Joint inflammation is the result of uptake of crystals by polymorphonuclear leucocytes.
Clinical features Classical gout is easily diagnosed. The typical patient is young or middle-aged, male, and wakes in the early hours of the morning with severe pain, usually in the big toe. Severe incidental illness. The affected joint is usually red, swollen and warm. The overlying skin is often shiny.