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General Medicine

Gout

David A. Ross, MD, CAQSM Reviewed 06/2019
 


BASICS

DESCRIPTION

  • Gout is an inflammatory arthritis related to a hyperuricemia (serum uric acid [SUA] level >6.8 mg/dL) (1)[C].

  • Acute gouty arthritis can affect ≥1 joint; the 1st metatarsophalangeal...

DIAGNOSIS

HISTORY

  • Classic presentation of acute gouty arthritis:

    • Intense pain and tenderness in the 1st metatarsophalangeal joint (podagra)

    • Can occur in the midtarsal, ankle, or knee joints

    • Joint may be s...

TREATMENT

GENERAL MEASURES

Topical ice as needed (5)[B] 

MEDICATION

  • Acute treatment

    • General principles:

      • Acute gouty arthritis attacks should be treated with pharmacologic therapy (5)[C].

      • Pharmacologic treat...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • SUA q2–5wk while titrating urate-lowering treatment to goal (1)[C]

  • Regularly monitor CBC, renal function, liver function test, and urinalysis.

DIET

REFERENCES

1
Khanna D, Fitzgerald JD, Khanna PP, et al; for American College of Rheumatology. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologi...

ADDITIONAL READING

Neogi T, Jansen T, Dalbeth N, et al. 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rh...

CODES

ICD10

  • M10.9 Gout, unspecified

  • M10.00 Idiopathic gout, unspecified site

  • M10.30 Gout due to renal impairment, unspecified site

  • M1A.30X0 Chronic gout due to renal impairment, unsp site, w/o tophus

  • M1A.9...

CLINICAL PEARLS

  • MSU crystals found in synovial fluid aspirate are pathognomonic for gout.

  • Pharmacologic treatment should begin within 24 hours of acute gout flare.

  • Asymptomatic hyperuricemia does not re...

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Related Images
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Chronic tophaceous gout involving the hands and wrists.
Chronic tophaceous gout involving the hands and wrists.
Gout in Knee Labeled
Gout in Knee Labeled
Gouty (uric acid) tophi in a middle-aged woman with longstanding gout
Gouty (uric acid) tophi in a middle-aged woman with longstanding gout
Gouty (uric acid) tophi in a middle-aged woman with longstanding gout
Gouty (uric acid) tophi in a middle-aged woman with longstanding gout
FIG. 4.4. This "chalky" substance was aspirated from a patient's inflamed olecranon bursa, an appearance that is virtually diagnostic of tophaceous gout.
FIG. 4.4. This "chalky" substance was aspirated from a patient's inflamed olecranon bursa, an appearance that is virtually diagnostic of to...
Fig B 10-17. Gout. Two examples of typical rat-bite erosions about the first metatarsophalangeal joint (arrows). The cystlike lesions have thin sclerotic margins and characteristic overhanging edges.
Fig B 10-17. Gout. Two examples of typical rat-bite erosions about the first metatarsophalangeal joint (arrows). The cystlike lesions have ...
Fig B 10-18. Gout. Diffuse deposition of urate crystals in periarticular tissues of the hand produce multiple large, lumpy soft-tissue swellings representing gouty tophi. Note the erosive changes that typically involve the carpal bones and the distal interphalangeal and metacarpophalangeal joints of the fifth digits.
Fig B 10-18. Gout. Diffuse deposition of urate crystals in periarticular tissues of the hand produce multiple large, lumpy soft-tissue swel...
Figure 10-207 SKELETAL DISTRIBUTION OF GOUT.
Figure 10-207 SKELETAL DISTRIBUTION OF GOUT.
Figure 10-210 GOUT: BONE EROSIONS. PA Foot. Observe the marginal erosion, demonstrating a classic overhanging margin sign (arrow), periarticular erosion (arrowhead), and intraosseous erosion (crossed arrow).
Figure 10-210 GOUT: BONE EROSIONS. PA Foot. Observe the marginal erosion, demonstrating a classic overhanging margin sign (arrow), periarti...
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