Gout is a common form of inflammatory arthritis, seen more often in men and increasing in prevalence with age. The diagnosis can be made on a typical history of recurrent episodes or crystal identification using polarised microscopy.
Mr Liew is a 50-year-old Chinese man who presents to the medical centre for the third time in two years. A diagnosis of gout in his right first metatarsophalangeal (MTP) joint was made at each previous presentation. He requests colchicine at this visit (as he was prescribed this previously). Mr Liew’s uric acid level (initially measured two years ago) was raised at 0.46mmol/L (reference range, 0.20 to 0.42mmol/L) and his kidney function was normal. Mr Liew drinks 20g of alcohol (red wine) daily and up to 60g daily on weekends. He works as a stockbroker and has a stressful job; he does not always stop to eat and drink when at work. There is no family history of gout.