Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • rapid-onset severe pain
  • joint stiffness
  • foot joint distribution
  • few affected joints
  • swelling and joint effusion
  • tenderness
  • tophi

Other diagnostic factors

  • erythema and warmth
  • family history of gout

Risk factors

  • older age
  • male sex
  • menopausal status
  • consumption of meat, seafood, alcohol
  • use of diuretics
  • use of ciclosporin (cyclosporine) or tacrolimus
  • use of pyrazinamide
  • use of aspirin
  • genetic susceptibility
  • high cell turnover state
  • adiposity and insulin resistance
  • hypertension
  • renal insufficiency
  • diabetes mellitus
  • hyperlipidaemia

Diagnostic investigations

1st investigations to order

  • arthrocentesis with synovial fluid analysis
Full details

Investigations to consider

  • uric acid level
  • x-ray of affected joint
  • ultrasound
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Fadi Badlissi

Assistant Professor

Harvard Medical School

Attending Physician

Director of the Musculoskeletal Medicine Unit

Department of Orthopedics & Division of Rheumatology

Beth Israel Deaconess Medical Center

Boston

MA

Disclosures

FB declares that he has no competing interests.

Peer reviewers VIEW ALL

Professor of Medicine

VA Medical Center

Philadelphia

PA

Disclosures

HRS has been a consultant for a number of pharmaceutical companies that produce drugs that can be used for the treatment of gout. Some companies have supplied HRS with funding. HRS is an author of a number of references cited in this monograph.

Associate Director of Teaching and Honorary Senior Lecturer in Rheumatology

Academic Rheumatology Group

Faculty of Medicine

University of Sheffield

Sheffield

UK

Disclosures

AA declares that he has no competing interests.

Professor of Primary Care Research

Warwick Medical School

Coventry

UK

Disclosures

MU declares that he has no competing interests.

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