A person has severe pain & swelling in great toe.True statements are -a) Allopurinol used in acute control of goutb) Colchicine acts slowlyc) Colchicine cause gastrointestinal disturbancesd) High serum uric acid level may be not presente) Joint fluid aspiration is done for investigation
**Core Concept**
The question tests the understanding of gout, a form of inflammatory arthritis characterized by the deposition of monosodium urate crystals in the joints. The condition often presents with acute monoarticular pain, particularly in the big toe (podagra).
**Why the Correct Answer is Right**
Gout is caused by elevated serum uric acid levels, which can be due to overproduction, underexcretion, or a combination of both. Allopurinol is a xanthine oxidase inhibitor that reduces uric acid production and is typically used for long-term management (not acute control). Colchicine is a uricosuric agent that acts rapidly to reduce inflammation and pain in acute gout attacks, despite its slow onset of action. Colchicine can cause gastrointestinal disturbances, such as diarrhea and nausea, as a side effect. High serum uric acid levels may not always be present in acute gout attacks, as the level of uric acid may be normal or even low. Joint fluid aspiration is a diagnostic tool used to identify the presence of monosodium urate crystals, which is a hallmark of gout.
**Why Each Wrong Option is Incorrect**
**Option A:** Allopurinol is used for long-term management of gout, not acute control. It is not effective in reducing inflammation and pain in acute attacks.
**Option B:** Colchicine acts rapidly to reduce inflammation and pain in acute gout attacks, despite its slow onset of action.
**Option C:** Colchicine is a correct statement, as it can cause gastrointestinal disturbances.
**Option D:** High serum uric acid levels may be present in chronic gout, but not always in acute attacks.
**Clinical Pearl / High-Yield Fact**
In gout, the level of serum uric acid may be normal or even low in acute attacks, making it an unreliable diagnostic criterion. Joint fluid aspiration is a critical diagnostic tool for identifying monosodium urate crystals.
**Correct Answer: E. Joint fluid aspiration is done for investigation**