Gout differential diagnosis: Difference between revisions
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*[[Septic arthritis]] | *[[Septic arthritis]] | ||
*[[Sarcoidosis]] | *[[Sarcoidosis]] | ||
Gout must be differentiated from other diseases that cause [[bone pain]], [[edema]], and [[erythema]]. | |||
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center | |||
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! style="background: #4479BA; width: 180px;" | {{fontcolor|#ffffff|Disease}} | |||
! style="background: #4479BA; width: 650px;" | {{fontcolor|#ffffff|Findings}} | |||
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| style="padding: 7px 7px; background: #DCDCDC;" | '''Soft tissue infection'''<br> (Commonly [[cellulitis]]) | |||
| style="padding: 7px 7px; background: #F5F5F5;" | History of skin warmness, swelling and erythema. Bone probing is the definite way to differentiate them.<ref name="pmid8532002">{{cite journal |vauthors=Bisno AL, Stevens DL |title=Streptococcal infections of skin and soft tissues |journal=N. Engl. J. Med. |volume=334 |issue=4 |pages=240–5 |year=1996 |pmid=8532002 |doi=10.1056/NEJM199601253340407 |url=}}</ref><ref name="pmid24947530">{{cite journal |vauthors=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL, Hirschmann JV, Kaplan SL, Montoya JG, Wade JC |title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America |journal=Clin. Infect. Dis. |volume=59 |issue=2 |pages=147–59 |year=2014 |pmid=24947530 |doi=10.1093/cid/ciu296 |url=}}</ref> | |||
|- | |||
| style="padding: 7px 7px; background: #DCDCDC;" |'''[[Osteonecrosis]]'''<br>(Avascular necrosis of bone) | |||
| style="padding: 7px 7px; background: #F5F5F5;" |Previous history of trauma, radiation, use of steroids or biphosphonates are suggestive to differentiate osteonecrosis from ostemyelitis.<ref name="pmid21865285">{{cite journal |vauthors=Shigemura T, Nakamura J, Kishida S, Harada Y, Ohtori S, Kamikawa K, Ochiai N, Takahashi K |title=Incidence of osteonecrosis associated with corticosteroid therapy among different underlying diseases: prospective MRI study |journal=Rheumatology (Oxford) |volume=50 |issue=11 |pages=2023–8 |year=2011 |pmid=21865285 |doi=10.1093/rheumatology/ker277 |url=}}</ref><ref name="pmid25480307">{{cite journal |vauthors=Slobogean GP, Sprague SA, Scott T, Bhandari M |title=Complications following young femoral neck fractures |journal=Injury |volume=46 |issue=3 |pages=484–91 |year=2015 |pmid=25480307 |doi=10.1016/j.injury.2014.10.010 |url=}}</ref><br> MRI is diagnostic.<ref name="pmid22022684">{{cite journal |vauthors=Amanatullah DF, Strauss EJ, Di Cesare PE |title=Current management options for osteonecrosis of the femoral head: part 1, diagnosis and nonoperative management |journal=Am J. Orthop. |volume=40 |issue=9 |pages=E186–92 |year=2011 |pmid=22022684 |doi= |url=}}</ref><ref name="pmid15116601">{{cite journal |vauthors=Etienne G, Mont MA, Ragland PS |title=The diagnosis and treatment of nontraumatic osteonecrosis of the femoral head |journal=Instr Course Lect |volume=53 |issue= |pages=67–85 |year=2004 |pmid=15116601 |doi= |url=}}</ref> | |||
|- | |||
| style="padding: 7px 7px; background: #DCDCDC;" |'''[[Charcot arthropathy|Charcot joint]]''' | |||
| style="padding: 7px 7px; background: #F5F5F5;" |Patients with [[Charcot arthropathy|Charcot joint]] commonly develop skin ulcerations that can in turn lead to secondary osteomyelitis.<br>Contrast-enhanced MRI may be diagnostically useful if it shows a sinus tract, replacement of soft tissue fat, a fluid collection, or extensive marrow abnormalities. Bone biopsy is the definitive diagnostic modality.<ref name="pmid16436821">{{cite journal |vauthors=Ahmadi ME, Morrison WB, Carrino JA, Schweitzer ME, Raikin SM, Ledermann HP |title=Neuropathic arthropathy of the foot with and without superimposed osteomyelitis: MR imaging characteristics |journal=Radiology |volume=238 |issue=2 |pages=622–31 |year=2006 |pmid=16436821 |doi=10.1148/radiol.2382041393 |url=}}</ref> | |||
|- | |||
| style="padding: 7px 7px; background: #DCDCDC;" |'''[[Bone tumors]]''' | |||
| style="padding: 7px 7px; background: #F5F5F5;" |May present with local pain and radiographic changes consistent with osteomyelitis. <br>Tumors most likely to mimic osteomyelitis are ''osteoid osteomas'' and ''chondroblastomas'' that produce small, round, radiolucent lesions on radiographs.<ref>{{cite book | last = Lovell | first = Wood | title = Lovell and Winter's pediatric orthopaedics | publisher = Wolters Kluwer Health/Lippincott Williams & Wilkins | location = Philadelphia | year = 2014 | isbn = 978-1605478142 }}</ref> | |||
|- | |||
| style="padding: 7px 7px; background: #DCDCDC;" |'''[[Gout]]''' | |||
| style="padding: 7px 7px; background: #F5F5F5;" |Gout presents with [[joint pain]] and [[swelling]]. Joint aspiration and crystals in synovial fluid is diagnostic for gout.<ref name="pmid20662061">{{cite journal |vauthors=Joosten LA, Netea MG, Mylona E, Koenders MI, Malireddi RK, Oosting M, Stienstra R, van de Veerdonk FL, Stalenhoef AF, Giamarellos-Bourboulis EJ, Kanneganti TD, van der Meer JW |title=Engagement of fatty acids with Toll-like receptor 2 drives interleukin-1β production via the ASC/caspase 1 pathway in monosodium urate monohydrate crystal-induced gouty arthritis |journal=Arthritis Rheum. |volume=62 |issue=11 |pages=3237–48 |year=2010 |pmid=20662061 |pmc=2970687 |doi=10.1002/art.27667 |url=}}</ref> | |||
|- | |||
| style="padding: 7px 7px; background: #DCDCDC;" |'''[[SAPHO syndrome]]'''<br>(Synovitis, acne, pustulosis, hyperostosis, and osteitis) | |||
| style="padding: 7px 7px; background: #F5F5F5;" |[[SAPHO syndrome]] consists of a wide spectrum of neutrophilic [[dermatosis]] associated with aseptic osteoarticular lesions. <br>It can mimic osteomyelitis in patients who lack the characteristic findings of pustulosis and [[synovitis]]. <br>The diagnosis is established via clinical manifestations; bone culture is sterile in the setting of [[osteitis]]. | |||
|- | |||
| style="padding: 7px 7px; background: #DCDCDC;" |'''[[Sarcoidosis]]''' | |||
| style="padding: 7px 7px; background: #F5F5F5;" |It involves most frequently the pulmonary [[parenchyma]] and mediastinal lymph nodes, but any organ system can be affected. <br>Bone involvement is often bilateral and bones commonly affected include the middle and distal phalanges (producing “sausage finger”), wrist, skull, vertebral column, and long bones. | |||
|- | |||
| style="padding: 7px 7px; background: #DCDCDC;" |'''[[Langerhans' cell histiocytosis]]''' | |||
| style="padding: 7px 7px; background: #F5F5F5;" |The disease usually manifests in the skeleton and solitary bone lesions are encountered twice as often as multiple bone lesions.<br>The tumours can develop in any bone, but most commonly originate in the skull and jaw, followed by vertebral bodies, ribs, pelvis, and long bones.<ref name="pmid26461144">{{cite journal |vauthors=Picarsic J, Jaffe R |title=Nosology and Pathology of Langerhans Cell Histiocytosis |journal=Hematol. Oncol. Clin. North Am. |volume=29 |issue=5 |pages=799–823 |year=2015 |pmid=26461144 |doi=10.1016/j.hoc.2015.06.001 |url=}}</ref> | |||
|- | |||
|} | |||
==References== | ==References== | ||
Revision as of 05:53, 17 September 2017
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Overview
Gout needs to be differentiated from other diseases such as cellulitis, rheumatoid arthritis, septic arthritis and sarcoidosis as they present with similar symptoms.
Differentiating Gout from other Diseases
Certain diseases can present with similar symptoms like
Gout must be differentiated from other diseases that cause bone pain, edema, and erythema.
| Disease | Findings |
|---|---|
| Soft tissue infection (Commonly cellulitis) |
History of skin warmness, swelling and erythema. Bone probing is the definite way to differentiate them.[1][2] |
| Osteonecrosis (Avascular necrosis of bone) |
Previous history of trauma, radiation, use of steroids or biphosphonates are suggestive to differentiate osteonecrosis from ostemyelitis.[3][4] MRI is diagnostic.[5][6] |
| Charcot joint | Patients with Charcot joint commonly develop skin ulcerations that can in turn lead to secondary osteomyelitis. Contrast-enhanced MRI may be diagnostically useful if it shows a sinus tract, replacement of soft tissue fat, a fluid collection, or extensive marrow abnormalities. Bone biopsy is the definitive diagnostic modality.[7] |
| Bone tumors | May present with local pain and radiographic changes consistent with osteomyelitis. Tumors most likely to mimic osteomyelitis are osteoid osteomas and chondroblastomas that produce small, round, radiolucent lesions on radiographs.[8] |
| Gout | Gout presents with joint pain and swelling. Joint aspiration and crystals in synovial fluid is diagnostic for gout.[9] |
| SAPHO syndrome (Synovitis, acne, pustulosis, hyperostosis, and osteitis) |
SAPHO syndrome consists of a wide spectrum of neutrophilic dermatosis associated with aseptic osteoarticular lesions. It can mimic osteomyelitis in patients who lack the characteristic findings of pustulosis and synovitis. The diagnosis is established via clinical manifestations; bone culture is sterile in the setting of osteitis. |
| Sarcoidosis | It involves most frequently the pulmonary parenchyma and mediastinal lymph nodes, but any organ system can be affected. Bone involvement is often bilateral and bones commonly affected include the middle and distal phalanges (producing “sausage finger”), wrist, skull, vertebral column, and long bones. |
| Langerhans' cell histiocytosis | The disease usually manifests in the skeleton and solitary bone lesions are encountered twice as often as multiple bone lesions. The tumours can develop in any bone, but most commonly originate in the skull and jaw, followed by vertebral bodies, ribs, pelvis, and long bones.[10] |
References
- ↑ Bisno AL, Stevens DL (1996). "Streptococcal infections of skin and soft tissues". N. Engl. J. Med. 334 (4): 240–5. doi:10.1056/NEJM199601253340407. PMID 8532002.
- ↑ Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL, Hirschmann JV, Kaplan SL, Montoya JG, Wade JC (2014). "Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America". Clin. Infect. Dis. 59 (2): 147–59. doi:10.1093/cid/ciu296. PMID 24947530.
- ↑ Shigemura T, Nakamura J, Kishida S, Harada Y, Ohtori S, Kamikawa K, Ochiai N, Takahashi K (2011). "Incidence of osteonecrosis associated with corticosteroid therapy among different underlying diseases: prospective MRI study". Rheumatology (Oxford). 50 (11): 2023–8. doi:10.1093/rheumatology/ker277. PMID 21865285.
- ↑ Slobogean GP, Sprague SA, Scott T, Bhandari M (2015). "Complications following young femoral neck fractures". Injury. 46 (3): 484–91. doi:10.1016/j.injury.2014.10.010. PMID 25480307.
- ↑ Amanatullah DF, Strauss EJ, Di Cesare PE (2011). "Current management options for osteonecrosis of the femoral head: part 1, diagnosis and nonoperative management". Am J. Orthop. 40 (9): E186–92. PMID 22022684.
- ↑ Etienne G, Mont MA, Ragland PS (2004). "The diagnosis and treatment of nontraumatic osteonecrosis of the femoral head". Instr Course Lect. 53: 67–85. PMID 15116601.
- ↑ Ahmadi ME, Morrison WB, Carrino JA, Schweitzer ME, Raikin SM, Ledermann HP (2006). "Neuropathic arthropathy of the foot with and without superimposed osteomyelitis: MR imaging characteristics". Radiology. 238 (2): 622–31. doi:10.1148/radiol.2382041393. PMID 16436821.
- ↑ Lovell, Wood (2014). Lovell and Winter's pediatric orthopaedics. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 978-1605478142.
- ↑ Joosten LA, Netea MG, Mylona E, Koenders MI, Malireddi RK, Oosting M, Stienstra R, van de Veerdonk FL, Stalenhoef AF, Giamarellos-Bourboulis EJ, Kanneganti TD, van der Meer JW (2010). "Engagement of fatty acids with Toll-like receptor 2 drives interleukin-1β production via the ASC/caspase 1 pathway in monosodium urate monohydrate crystal-induced gouty arthritis". Arthritis Rheum. 62 (11): 3237–48. doi:10.1002/art.27667. PMC 2970687. PMID 20662061.
- ↑ Picarsic J, Jaffe R (2015). "Nosology and Pathology of Langerhans Cell Histiocytosis". Hematol. Oncol. Clin. North Am. 29 (5): 799–823. doi:10.1016/j.hoc.2015.06.001. PMID 26461144.