How is gout presentation?

➢ Chronic gout occurs approximately 12 years after the initial acute attack. ➢ It is marked by the deposit of urate crystals in a chalky mass called tophi: can appear around a joint. ➢ Joint aspiration during an acute gouty attack shows increased turbidity, reduced viscosity and leukocytosis with many neutrophils. ➢ On microscopy, monosodium urate crystals needle-shaped birefringent appear in the liquid. ➢ The inflammation in gout is triggered by precipitation of urate crystals in the joints, stimulating the production of cytokines that recruit leukocytes ➢ Chronic Tophaceal gout results from the repetitive precipitation of uraye crystals during acute gout attacks. ➢ MSU crystals cause surrounding destructive inflammatory response ➢ Tophi most commonly forms around joints, in soft tissue, including tendons and ligaments, and less commonly in visceral organs. ➢ The tophi can erode and destroy the adjacent bone. ➢ Urate can also form in the kidneys, and around 20% of gout patients may eventually develop kidney failur