True statements regarding acute attack of gouty ahritis is all EXCEPT:
**Core Concept**
Acute gouty arthritis is a type of inflammatory arthritis characterized by sudden onset of intense pain, swelling, redness, and tenderness in one or more joints, typically the base of the big toe. The condition is caused by deposition of monosodium urate crystals in the joint space, leading to activation of the immune system and subsequent inflammation.
**Why the Correct Answer is Right**
The correct answer is related to the pathophysiology of acute gouty arthritis. Gout is caused by elevated levels of uric acid in the blood, which can be due to increased production, decreased excretion, or a combination of both. The deposition of monosodium urate crystals in the joint space triggers an inflammatory response, characterized by the release of various cytokines and chemokines, including interleukin-1 beta (IL-1β) and tumor necrosis factor-alpha (TNF-α). These molecules attract neutrophils to the affected joint, leading to the characteristic symptoms of gout.
**Why Each Wrong Option is Incorrect**
**Option A:** This statement is incorrect because acute gouty arthritis is not typically associated with joint effusion. While joint effusion can occur in some cases, it is not a hallmark feature of the condition.
**Option B:** This statement is incorrect because hyperuricemia is a common finding in patients with acute gouty arthritis. Elevated levels of uric acid in the blood can lead to the deposition of monosodium urate crystals in the joint space, triggering an inflammatory response.
**Option C:** This statement is incorrect because acute gouty arthritis is not typically associated with a positive rheumatoid factor. Rheumatoid factor is an antibody that is often present in patients with rheumatoid arthritis, but not in those with gout.
**Option D:** This statement is incorrect because acute gouty arthritis is not typically associated with a low erythrocyte sedimentation rate (ESR). In fact, the ESR is often elevated in patients with gout due to the underlying inflammatory response.
**Clinical Pearl / High-Yield Fact**
A classic clinical feature of acute gouty arthritis is the presence of tophi, which are deposits of monosodium urate crystals that can be found in the skin, cartilage, and other tissues. Tophi are often associated with chronic gout and can be a sign of long-standing disease.
**Correct Answer:**
A.