Gout

Acute Gout causes flares of monoarticular arthritis
  • Joint swollen & tender
  • 1st Toe, Knee, Ankle, Wrist are most common
  • Abrupt onset (within 24 hrs)
  • duration ~1 week, resolves
Chronic Gout may cause episodes of large or small joint arthritis
  • For undiagnosed patient,  seek Hx of prior typical gouty flares
  • Seek Tophi — urate deposits in pinna & bursa [see pix below]
Key Modifiable Risk Factors:
  • Beer & Liquor (not wine)
  • Diuretics; maybe low-dose aspirin
↑ serum Uric Acid NOT helpful unless presents with typical gout attack
  • High uric acid common among general population
  • May be normal in acute Gout
  • Best time to order is >2 wks after acute attack has subsided
If able to tap joint, send fluid “for crystals” (by polarizing microscope):
  • “urate” or “negatively bifringent” crystals = Gout
Complications:
  • Joint Erosions (get X-Rays for chronic gout)
  • Renal Stones
  • Renal Failure (follow Creatinine; ? 24-hr urine for Uric Acid)

See also postings Monoarticular Arthritis and Polyarthralgias.

Tophi