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| __NOTOC__ | | __NOTOC__ |
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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
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| {{Infobox_Disease |
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| Name = Gout |
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| Image = upper_tophaceous_gout.jpg |
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| Caption = Tophaceous Gout <br> (Image courtesy of Charlie Goldberg, M.D.)|
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| }}
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| {{Gout}} | | {{Gout}} |
| {{CMG}}; {{AE}} {{CZ}} | | {{CMG}} {{AE}} {{Shivam Singla}} |
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| {{SK}} Urate crystal arthropathy; uric acid crystal deposition in joint; gouty arthritis; podagra | | {{SK}} Urate crystal arthropathy; uric acid crystal deposition in joint; gouty arthritis; podagra |
| == [[Gout overview|Overview]] ==
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| == [[Gout historical perspective|Historical Perspective]] == | | ==[[Gout overview|Overview]]== |
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| == [[Gout pathophysiology|Pathophysiology]]== | | ==[[Gout historical perspective|Historical Perspective]]== |
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| == [[Gout differential diagnosis|Differentiating Gout from other Diseases]] == | | ==[[Gout pathophysiology|Pathophysiology]]== |
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| == [[Gout epidemiology and demographics|Epidemiology and Demographics]] == | | ==[[Gout differential diagnosis|Differentiating Gout from other Diseases]]== |
| | ==[[Gout epidemiology and demographics|Epidemiology and Demographics]]== |
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| == [[Gout risk factors|Risk Factors]] == | | ==[[Gout risk factors|Risk Factors]]== |
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| == [[Gout screening|Screening]] == | | ==[[Gout screening|Screening]]== |
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| == [[Gout natural history, complications and prognosis|Natural History, Complications and Prognosis]] == | | ==[[Gout natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==[[Diagnosis]]== | | ==[[Diagnosis]]== |
| | | [[Gout staging|Staging]] | [[Gout history and symptoms|History and Symptoms]] | [[Gout physical examination|Physical Examination]] | [[Gout laboratory tests|Laboratory Findings]] | [[Gout electrocardiogram|Electrocardiogram]] | [[Gout x ray|X Ray]] | [[Gout CT|CT]] | [[Gout MRI|MRI]] | [[Gout echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Gout other imaging findings|Other Imaging Findings]] | [[Gout other diagnostic studies|Other Diagnostic Studies]] |
| {| class="wikitable" align="right"
| | ==[[Treatment]]== |
| |+ Accuracy of diagnostic criteria for gout among patients who had [[synovial fluid]] analysis
| | [[Gout medical therapy|Medical Therapy]] | [[Gout surgery|Surgery]] | [[Gout primary prevention|Primary Prevention]] | [[Gout secondary prevention|Secondary Prevention]] | [[Gout cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Gout future or investigational therapies|Future or Investigational Therapies]] |
| <ref name="pmid19125136">{{cite journal| author=Malik A, Schumacher HR, Dinnella JE, Clayburne GM| title=Clinical diagnostic criteria for gout: comparison with the gold standard of synovial fluid crystal analysis. | journal=J Clin Rheumatol | year= 2009 | volume= 15 | issue= 1 | pages= 22-4 | pmid=19125136 | doi=10.1097/RHU.0b013e3181945b79 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19125136 }} </ref>
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| ! !! Criteria!!Sensitivity !! Specificity
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| | ARA (ACR)||6 of 12 criteria|| align="center" | 70% || align="center" | 79%
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| | Rome||2 of 4 criteria:<br />• Painful joint swelling, abrupt onset, Clearing in 1-2 weeks initially<br />• Serum uric acid: >7 in males; >6 in females<br />• Presence of tophi<br />• Urate crystals in synovial fluid or tissues|| align="center" | 70% || align="center" | 83%
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| | New York||2 of 5 criteria:<br />• 2 attacks of painful limb joint swelling<br />• Abrupt onset and remission in 1—2 weeks initially<br />• First MTP attack<br />• Presence of a tophus<br />• Response to colchicine-major reduction in inflammation within 48 h|| align="center" | 67% || align="center" | 89%
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| |}
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| The favored approach to the diagnosis of gout is based upon the identification of intracellular monosodium urate (MSU) crystals found in the synovial fluid aspirate of an affected joint, under polarizing light microscopy. But when this is not possible, a clinical diagnosis can be deduced with the help of classical clinical features, including the history and physical examination, laboratory findings, and various imaging studies.
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| Several sets of diagnostic criteria exit (see table).<ref name="pmid19125136">{{cite journal| author=Malik A, Schumacher HR, Dinnella JE, Clayburne GM| title=Clinical diagnostic criteria for gout: comparison with the gold standard of synovial fluid crystal analysis. | journal=J Clin Rheumatol | year= 2009 | volume= 15 | issue= 1 | pages= 22-4 | pmid=19125136 | doi=10.1097/RHU.0b013e3181945b79 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19125136 }} </ref>
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| {| class="wikitable" align="right"
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| |+ The serum uric acid level during an attack of gout<ref name="pmid20625017">{{cite journal| author=Janssens HJ, Fransen J, van de Lisdonk EH, van Riel PL, van Weel C, Janssen M| title=A diagnostic rule for acute gouty arthritis in primary care without joint fluid analysis. | journal=Arch Intern Med | year= 2010 | volume= 170 | issue= 13 | pages= 1120-6 | pmid=20625017 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20625017 | doi=10.1001/archinternmed.2010.196 }} </ref><ref name="pmid19369457">{{cite journal |author=Schlesinger N, Norquist JM, Watson DJ |title=Serum urate during acute gout |journal=J. Rheumatol. |volume=36 |issue=6 |pages=1287–9 |year=2009 |month=June |pmid=19369457 |doi=10.3899/jrheum.080938 |url=http://www.jrheum.org/cgi/pmidlookup?view=long&pmid=19369457 |issn=}}</ref>
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| ! !! Sensitivity !! Specificity
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| | > 5.88 mg/dl<ref name="pmid20625017" />|| align="center" |95%|| align="center" |53%
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| | ≥ 6 mg/dl<ref name="pmid19369457" />|| align="center" | 86% || align="center" | ?
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| | ≥ 8 mg/dl<ref name="pmid19369457" />|| align="center" |68% || align="center" |?
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| |}
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| A [[clinical prediction rule]] (link to online version<ref name="pmid26926810">{{cite journal| author=Sylvester JE, Leggit JC| title=Diagnostic Tool for Gout Without Need for Joint Fluid Aspiration. | journal=Am Fam Physician | year= 2016 | volume= 93 | issue= 4 | pages= 256-8 | pmid=26926810 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26926810 }} </ref>) found that the following predicted urate crystals by aspiration:<ref name="pmid20625017">{{cite journal| author=Janssens HJ, Fransen J, van de Lisdonk EH, van Riel PL, van Weel C, Janssen M| title=A diagnostic rule for acute gouty arthritis in primary care without joint fluid analysis. | journal=Arch Intern Med | year= 2010 | volume= 170 | issue= 13 | pages= 1120-6 | pmid=20625017 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20625017 | doi=10.1001/archinternmed.2010.196 }} </ref>
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| * Male
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| * Onset within one day
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| * Joint redness
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| * First metatarsaophalangeal joint
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| * Previous arthritis attack per patient
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| * History of hypertension or 1 or more [[cardiovascular disease]]s
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| * Serum [[uric acid]] level > 5.88 mg/dl
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| However, among patients with high scores, 20% did not have crystals. Only one of 381 patients had bacterial arthritis.
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| ==Treatment== | |
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| [[Gout medical therapy|Medical Therapy]] | [[Gout surgery|Surgery]] | [[Gout secondary prevention|Secondary Prevention]] | [[Gout cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Gout future or investigational therapies|Future or Investigational Therapies]] | |
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| ==Case Studies==
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| :[[Gout case study one|Case #1]]
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| ==Related Chapter==
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| * [[Pseudogout]]
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| ==External Links==
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| * {{cite web | title=Answers and Questions on Gout| url=http://www.niams.nih.gov/Health_Info/Gout/default.asp | publisher= U.S. [[National Institutes of Health]]—[[National Institute of Arthritis and Musculoskeletal and Skin Diseases]] |date=September 28th, 2007 | accessdate=2007-08-28}}
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| * {{cite web | title=Coffee Consumption and Reduced Gout Risk | url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17530645 | work= Drinking coffee reduces risk of gout in middle age men | publisher= U.S. [[National Institutes of Health]] | accessdate=2007-05-25}}
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| ==References==
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| {{Reflist|2}}
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| {{Diseases of the musculoskeletal system and connective tissue}}
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| [[Category:Arthritis]]
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| [[Category:Rheumatology]]
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| [[Category:Disease]]
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| [[Category:Primary care]]
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| {{WH}}
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| {{WS}}
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| [[ar:نقرس]]
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| [[bg:Подагра]]
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| [[cs:Dna]]
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| [[da:Gigt]]
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| [[de:Gicht]]
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| [[es:Gota (enfermedad)]]
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| [[eo:Podagro]]
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| [[fa:نقرس]]
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| [[fr:Arthrite goutteuse]]
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| [[io:Kiragro]]
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| [[id:Gout]]
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| [[it:Gotta]]
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| [[he:שיגדון]]
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| [[lb:Giicht]]
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| [[ms:Gout]]
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| [[nl:Jicht]]
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| [[ja:痛風]]
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| [[no:Urinsyregikt]]
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| [[pl:Dna moczanowa]]
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| [[pt:Gota (doença)]]
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| [[ru:Подагра]]
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| [[sk:Dna]]
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| [[sr:Гихт]]
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| [[fi:Kihti]]
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| [[sv:Gikt]]
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| [[te:గౌటు]]
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| [[tr:Gut hastalığı]]
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| [[zh:痛风]]
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