26th January 2024

Gout and pseudogout

Gout and pseudogout usually present with an acute monoarthritis; however, they can both mimic an acute exacerbation of OA. A joint affected by gout or pseudogout is usually warm, erythematous and tender to palpation. Joint fluid analysis can be used to distinguish between the conditions. The most commonly affected joint in gout is the first metatarsophalangeal joint. Gout will be suspected in the presence of sodium monourate crystals present in the synovium. The serum uric acid level would also be raised (> 450 µmol/l). Pseudogout usually occurs in the wrist and knee but can also involve MCPs. Pyrophosphate crystals would be found on joint fluid analysis, and x-rays would demonstrate features such as chondrocalcinosis.