Gout
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| Tophaceous Gout (Image courtesy of Charlie Goldberg, M.D.) |
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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
History and Symptoms | Physical Examination | Laboratory Findings | X Ray | Ultrasonograpy |CT | MRI
| 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).[1]
| Sensitivity | Specificity | |
|---|---|---|
| > 5.88 mg/dl[2] | 95% | 53% |
| ≥ 6 mg/dl[3] | 86% | ? |
| ≥ 8 mg/dl[3] | 68% | ? |
A clinical prediction rule (link to online version[4]) found that the following predicted urate crystals by aspiration:[2]
- 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
Medical Therapy | Surgery | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies
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
- ↑ 1.0 1.1 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.
- ↑ 2.0 2.1 2.2 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.
- ↑ 3.0 3.1 3.2 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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