Gout: Difference between revisions
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[[File:Tophaceous gout-Rt-great-toe.jpg|thumb|'''Tophaceous gout affecting the right great toe and finger interphalangeal joints'''. Note the asymmetrical swelling and yellow-white discolouration.<ref name="Roddy2011">{{cite journal|last1=Roddy|first1=Edward|title=Revisiting the pathogenesis of podagra: why does gout target the foot?|journal=Journal of Foot and Ankle Research|volume=4|issue=1|year=2011|issn=1757-1146|doi=10.1186/1757-1146-4-13}}</ref>]] | [[File:Tophaceous gout-Rt-great-toe.jpg|thumb|'''Tophaceous gout affecting the right great toe and finger interphalangeal joints'''. Note the asymmetrical swelling and yellow-white discolouration.<ref name="Roddy2011">{{cite journal|last1=Roddy|first1=Edward|title=Revisiting the pathogenesis of podagra: why does gout target the foot?|journal=Journal of Foot and Ankle Research|volume=4|issue=1|year=2011|issn=1757-1146|doi=10.1186/1757-1146-4-13}}</ref>]] | ||
__NOTOC__ | __NOTOC__ | ||
'''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | ||
{{Gout}} | {{Gout}} | ||
{{CMG}}; {{AE}} {{CZ}} | {{CMG}}; {{AE}} {{CZ}} | ||
{{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]] == | == [[Gout overview|Overview]] == | ||
Revision as of 23:00, 25 April 2018
For patient information click here
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Gout Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Gout On the Web |
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American Roentgen Ray Society Images of Gout |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2] Synonyms and keywords: Urate crystal arthropathy; uric acid crystal deposition in joint; gouty arthritis; podagra
Overview
Historical Perspective
Pathophysiology
Differentiating Gout from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
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.
| Criteria | Sensitivity | Specificity | |
|---|---|---|---|
| ARA (ACR) | 6 of 12 criteria | 70% | 79% |
| Rome | 2 of 4 criteria: • Painful joint swelling, abrupt onset, Clearing in 1-2 weeks initially • Serum uric acid: >7 in males; >6 in females • Presence of tophi • Urate crystals in synovial fluid or tissues |
70% | 83% |
| New York | 2 of 5 criteria: • 2 attacks of painful limb joint swelling • Abrupt onset and remission in 1—2 weeks initially • First MTP attack • Presence of a tophus • Response to colchicine-major reduction in inflammation within 48 h |
67% | 89% |
Several sets of diagnostic criteria exit (see table).[2]
| Sensitivity | Specificity | |
|---|---|---|
| > 5.88 mg/dl[3] | 95% | 53% |
| ≥ 6 mg/dl[4] | 86% | ? |
| ≥ 8 mg/dl[4] | 68% | ? |
A clinical prediction rule (link to online version[5]) found that the following predicted urate crystals by aspiration:[3]
- Male
- Onset within one day
- Joint redness
- First metatarsaophalangeal joint
- Previous arthritis attack per patient
- History of hypertension or 1 or more cardiovascular diseases
- Serum uric acid level > 5.88 mg/dl
However, among patients with high scores, 20% did not have crystals. Only one of 381 patients had bacterial arthritis.
Treatment
Case Studies
Related Chapter
External Links
- "Answers and Questions on Gout". U.S. National Institutes of Health—National Institute of Arthritis and Musculoskeletal and Skin Diseases. September 28th, 2007. Retrieved 2007-08-28. Check date values in:
|date=(help) - "Coffee Consumption and Reduced Gout Risk". Drinking coffee reduces risk of gout in middle age men. U.S. National Institutes of Health. Retrieved 2007-05-25.
References
- ↑ Roddy, Edward (2011). "Revisiting the pathogenesis of podagra: why does gout target the foot?". Journal of Foot and Ankle Research. 4 (1). doi:10.1186/1757-1146-4-13. ISSN 1757-1146.
- ↑ 2.0 2.1 Malik A, Schumacher HR, Dinnella JE, Clayburne GM (2009). "Clinical diagnostic criteria for gout: comparison with the gold standard of synovial fluid crystal analysis". J Clin Rheumatol. 15 (1): 22–4. doi:10.1097/RHU.0b013e3181945b79. PMID 19125136.
- ↑ 3.0 3.1 3.2 Janssens HJ, Fransen J, van de Lisdonk EH, van Riel PL, van Weel C, Janssen M (2010). "A diagnostic rule for acute gouty arthritis in primary care without joint fluid analysis". Arch Intern Med. 170 (13): 1120–6. doi:10.1001/archinternmed.2010.196. PMID 20625017.
- ↑ 4.0 4.1 4.2 Schlesinger N, Norquist JM, Watson DJ (2009). "Serum urate during acute gout". J. Rheumatol. 36 (6): 1287–9. doi:10.3899/jrheum.080938. PMID 19369457. Unknown parameter
|month=ignored (help) - ↑ Sylvester JE, Leggit JC (2016). "Diagnostic Tool for Gout Without Need for Joint Fluid Aspiration". Am Fam Physician. 93 (4): 256–8. PMID 26926810.
Template:Diseases of the musculoskeletal system and connective tissue
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