Gout
Evaluation
General—inflammatory response to monosodium urate crystal deposition in joint(s)
Clinical
Acute—often begins at night with intense pain, redness, swelling, warmth, and decreased movement.
Affects first metatarsophalangeal joint in ” class=LK href=”javascript:void(0)” target=right xpath=”/CT{06b9ee1beed59419a81e5e1e1a4f60b0cc8cd1057525de73425b2b43f4df7f1b2b61020435fdb8f0cdfbb5b894c2833b}/ID(AB1-M10)”>>70% of cases; also tarsal joints, ankles, knees, wrists.
Usually monoarticular, but can be polyarticular (if so, fever is more likely).
Chronic—after approximately 10 years, the tophaceous phase occurs.
Mechanism
Hyperuricemia—secondary to
Insufficient renal excretion
Genetic predisposition (e.g., rare enzyme defects)
Chronic renal failure
Medications—loop or thiazide diuretics, low dose aspirin, cyclosporine
Urate overproduction
Urate rich food (meats—beef, pork, lamb)
Excess alcohol
Obesity (with insulin resistance) and decreased physical activity
Diseases of increased cell turnover (e.g., myeloproliferative or lymphoproliferative)
Diagnostic algorithm
Diagnostic—joint aspiration showing needle shaped, negatively birefringent urate crystals
Treatment
