Summary
Definition
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
- 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 rate
- obesity
- adiposity and insulin resistance
- exogenous insulin
- hypertension
- renal insufficiency
- diabetes mellitus
- hyperlipidaemia
- family history of gout
Diagnostic investigations
1st investigations to order
- arthrocentesis with synovial fluid analysis
Investigations to consider
- serum uric acid level
- ultrasound
- dual energy computed tomography (DECT)
- x-ray of affected joint
Treatment algorithm
acute gout
recurrent gout: 2-3 weeks post acute episode
Contributors
Authors
Fadi Badlissi, MD, MSc
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 has received an honorarium as an advisory board member for Horizon Pharmaceuticals.
Peer reviewers
H. Ralph Schumacher, Jr., MD
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 topic.
Ade Adebajo, MD
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.
Martin Underwood, MBBS
Professor of Primary Care Research
Warwick Medical School
Coventry
UK
Disclosures
MU declares that he has no competing interests.
Differentials
- Pseudogout (calcium pyrophosphate deposition disease)
- Septic arthritis
- Trauma
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- Treatment of gout
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