Gout is characterised by acute onset of severe joint pain, with swelling, effusion, warmth, erythema, and or tenderness of the involved joint(s).
Arthrocentesis with synovial fluid analysis shows strongly negative birefringent needle-shaped crystals under polarised light.
Non-steroidal anti-inflammatory drugs, colchicine, corticosteroids, or interleukin-1 inhibitors are used to treat acute disease.
Uric acid-lowering drugs (e.g., allopurinol, febuxostat, probenecid, or sulfinpyrazone) may be used when long-term prevention of crystal deposition is indicated.
Complications include joint destruction, kidney disease, and urolithiasis.
Gout is a syndrome characterised by: hyperuricaemia and deposition of urate crystals causing attacks of acute inflammatory arthritis; tophi around the joints and possible joint destruction; renal glomerular, tubular, and interstitial disease; and uric acid urolithiasis.
The disease most commonly affects the first toe (podagra), foot, ankle, knee, fingers, wrist, and elbow; however, it can affect any joint.
History and exam
Key diagnostic factors
- presence of risk factors
- men aged >40 years
- use of gout-inducing medication
- consumption of meat, seafood, or alcohol
- history of medical condition with high cell turnover rate
- rapid-onset severe pain
- joint stiffness
- foot joint distribution
- few affected joints
- swelling and joint effusion
Other diagnostic factors
- erythema and warmth
- family history of gout
- 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 rate
- adiposity and insulin resistance
- exogenous insulin
- renal insufficiency
- diabetes mellitus
- family history of gout
1st investigations to order
- arthrocentesis with synovial fluid analysis
Investigations to consider
- serum uric acid level
- dual energy computed tomography (DECT)
- x-ray of affected joint
recurrent gout: 2-3 weeks post acute episode
Fadi Badlissi, MD, MSc
Harvard Medical School
Director of the Musculoskeletal Medicine Unit
Department of Orthopedics & Division of Rheumatology
Beth Israel Deaconess Medical Center
FB has received an honorarium as an advisory board member for Horizon Pharmaceuticals.
H. Ralph Schumacher, Jr., MD
Professor of Medicine
VA Medical Center
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 topic.
Ade Adebajo, MD
Associate Director of Teaching and Honorary Senior Lecturer in Rheumatology
Academic Rheumatology Group
Faculty of Medicine
University of Sheffield
AA declares that he has no competing interests.
Martin Underwood, MBBS
Professor of Primary Care Research
Warwick Medical School
MU declares that he has no competing interests.
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