All of the following statements about primary Gouty Ahritis are true, Except:
Correct Answer: 90% of cases are caused by over production of uric acid
Description: Answer is A (90% of cases are caused by over production of uric acid): Diagnosis & Treatment in Rheumatology `Fewer than 5% of cases are caused by over production of uric acid'- Current Rheumatology Most 90%) cases of gout result from hyperuricemia secondary to decreased uric acid excretion by the kidneys and not from over production of uric acid. Most patients with Gout have hyperuricemia due to decreased uric acid excretion by the kidney The underlying basis of gout is an increased total body urate pool. This is generally manifested as hypercuricemia and persistant hyperuricemia is the most impoant risk factor for gouty ahritis (Although hyperuricemia alone is not synonymous with gout) This hyperuricemia can result from increased urate production or decreased uric acid excretion by the kidneys or a combination of both mechanisms The most common mechanism of hyperuricemia in gout is a defect in the renal handing of uric acid (and not uric acid over production). `Over 90% of individuals with sustained hyper uricemia have a defect in the renal handling of uric acid' `Fewer than 5% of patients with gout are hyper uricemic because of urate overproduction' -- Current Rheumatology Uric Acid levels may be normal at the time of an acute attack - Although most patients with acute gouty ahritis have associated hyperuricemia, elevated uric acid levels are not essential for the diagnosis of gout. This limits the value of serum uric acid determinations for the diagnosis of gout. Gout is caused whenever,synol fluid is supersaturated with uric acid, irrespective of serum concentration of uric acid. The serum levels of uric acid can be normal or even low at the time of an attack and hence its determination is not diagnostic for gout. Gout is more common in Men than Women (Male > Female) Gout presents predominantly in men Women represent only 5-20% of all patients with gout Definitive diagnosis of gout requires aspiration of synol fluid Definitive diagnosis of gout requires aspiration of the involved joint and demonstration of intracellular monosodium urate crystals in synol fluid. Under polarized light these are demonstrated as "strongly negative birefringent needle shaped crystals." Demonstration of Strong negative birefringent needle shaped crystals of monosodium urate polarized light microscopy Tophi are aggregates of monosodium urate monohydrate crystals that form in extra aicular and aicular structures and cause deformity and destruction of hard and soft tissue.
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