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