Monosodium urate crystal arthropathy from chronic hyperuricaemia.
Clinical features
- • Rapid-onset severe monoarthritis, classically first MTP
- • Red hot swollen joint peaking within 12–24 h
- • Tophi in chronic disease
Investigations
- • Joint aspiration: negatively birefringent needle-shaped crystals — always exclude septic arthritis
- • Serum urate 4–6 weeks after the flare
- • U&E, glucose, lipids
Management
- • Acute: NSAID with PPI, or colchicine 500 mcg 2–4 times daily, or prednisolone 30–35 mg × 5 days
- • Intra-articular steroid for a single joint
- • Urate-lowering: allopurinol 100 mg titrated to urate <360 µmol/L
- • Continue urate-lowering therapy through flares with prophylaxis
Clinical pearls
- • Never withhold urate-lowering therapy during an acute attack if already established
- • Review diuretics, alcohol and purine-rich intake
Related in WardRound
Educational — verify locally.
