Clinical study of gout in North Kerala

Introduction Gout is a heterogeneous disorder, characterized by hyperuricaemia and urate crystal-induced arthritis. At a serum urate level, more than 6.8 mg/dL, the solubility limit of monosodium urate in the serum is reached and there is an increased risk of gout and renal stones. Aim To study the clinical pattern of gout in North Kerala and its associations. Materials and methods Patients with clinical and laboratory features suggestive of gout, who attended the Rheumatology Division at Calicut Medical College between December 2006 and March 2009 were included in this study. Informed written consent was obtained from all the patients. Detailed history and clinical examination, including musculoskeletal examination, was done as per the proforma designed for this study. Results A total of 83 patients were diagnosed with gout, of which 14 patients were either lost to follow-up or were not willing to participate in this study and were excluded. Sixty-nine patients were included in the final analysis. The male to female ratio was 16:1, with a mean age at onset of 50.7 (± 10.72) years. The mean disease duration was 32 (± 23.88) months. First, metatarsophalangeal (MTP) joint was the most common joint involved in 91.3% cases. However, ankle joint involvement was the commonest in the initial episode (39%). Overall, 10% patients had polyarticular involvement. Tophi were present in 26%, bursal involvement in 2.8% and 7.2% had normouricemic gout. Mean serum uric acid level was 9.26 (± 2.27) mg%. About 40.5% were hypertensive while 46.3% were obese. Sixteen per cent had renal calculi but none had renal failure or nephrocalcinosis. Intercritical period was less than 1 year in most of the patients. Most of the patients were under excretors of uric acid. No patient in the study group had secondary gout. Conclusion In our study, there was a significant male preponderance. The first attack of gout was in the fifth decade. First, MTP joint involvement occurred in > 90% while ankle joint was commonly involved in the initial attack. High incidence of renal calculi was noted.