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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
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 ...
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 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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