Patients present with one or more erythematous, swollen and painful joints with restricted movement. The big toe is frequently involved (podagra). Other commonly involved joints include the instep, ankle, knee and wrist joints. The attacks are sudden and typically last up to 8 to12 hours. Systemic involvement is rare and may be indicated by the presence of fever.
Entire Body System
The elderly patients were more likely to have fever (51.1%) during the attack than the young (20.8%) and middle-aged (30.8%) patients (P 0.001 by χ² test). [ncbi.nlm.nih.gov]
[ 713.6 ] Staphylococcus 711.0 Streptococcus 711.0 syphilis (see also Syphilis) 094.0 [ 711.4 ] syringomyelia 336.0 [ 713.5 ] thalassemia (see also Thalassemia) 282.40 [ 713.2 ] tuberculosis (see also Tuberculosis, arthritis) 015.9 [ 711.4 ] typhoid fever [icd9data.com]
Systemic involvement is rare and may be indicated by the presence of fever. A detailed history and physical examination is often sufficient to form a diagnosis. [symptoma.com]
Signs of acute joint gout Reddening, swelling, and extreme contact pain; Fever (due to cytokine production development of systemic inflammation). [lecturio.com]
Lupus Multiple sclerosis Osteoarthritis Osteoporosis Polymyositis Psoriatic arthritis Rheumatic fever Rheumatoid arthritis Scleroderma Type 1 diabetes [uvahealth.com]
Family History of Gout
The family history of gout was found in one-third of the cases (p 0.05). Uricemia was higher in cases than controls (p 0.05). [ncbi.nlm.nih.gov]
Having a strong family history of gout may increase one’s risk for gout, but this does not mean that everyone with a family history of gout will have the disorder. [my.clevelandclinic.org]
history of gout can be obtained in less than half patients' male / female ratio ranging from 7:1 to 9:1 females with gout tend to be postmenopausal; pathophysiology predisposing conditions: common chronic diseases assoc w/ gout include alcoholism, obesity [wheelessonline.com]
Gout most often affects the joints in the feet, particularly at the base of the big toe (swelling, pain, and redness of the big toe is called podagra). However, it also commonly affects other areas: the ankle, instep, knee, wrist, and elbow. [merckmanuals.com]
The big joint toe pain may be so severe that even the weight of bedsheets causes discomfort. Gouty arthritis is easily treated with nonsteroidal anti-inflammatory drugs (NSAIDs). [everydayhealth.com]
Big toe pain occurring on most days for at least a month within the last year was reported by 16% of those with gout compared to 6% of controls (adjusted OR 2.94, 95% CI 1.62 to 5.34). [jfootankleres.biomedcentral.com]
He had no history of joint pain or constitutional symptoms at the time of admission. An otoscopic examination of the left ear revealed subtotal tympanic membrane perforation, and white middle ear plaques were detected. [ncbi.nlm.nih.gov]
Acute gouty arthritis typically presents with rapid development of severe joint pain, swelling, and tenderness that reaches its maximum within just 6-12 h, especially with overlying erythema, most classically in the first metatarsophalangeal joint. [ncbi.nlm.nih.gov]
Outcomes included pain, bleeding, joint swelling, erythema, tenderness, activity limitation, response to therapy, quality of life, time to resolution, supplementary analgesics, and adverse events. [doi.org]
The surgery combined with decreasing trioxypurine treatment can improve the treatment outcome of gouty tophus. [ncbi.nlm.nih.gov]
Gouty tophus presenting at a soft tissue mass diagnosed by fine-needle aspiration: a case report. Diagn Cytopathol. 1996 ; 15: 246 – 9. Google Scholar Crossref Medline ISI 4. Mackford, BJ, Kincaid, RJ, Mackay, I. [doi.org]
Highly refractile, crystal-like lesions were found in the macula of a 62 year old male patient with chronically uncontrolled gout. [ncbi.nlm.nih.gov]
Clinical outcomes evaluated included pain, joint swelling and tenderness, activities of daily living, patient global assessment, recurrence, intermediate outcomes of serum urate levels, and harms. [ncbi.nlm.nih.gov]
These are the presence of a clear history of at least two attacks of painful joint swelling with complete resolution within two weeks, a clear history or observation of podagra, the presence of a tophus, and a rapid response to colchicine within 48 hours [doi.org]
If left untreated, gout can cause painful joint deformities and lead to kidney disease. Gout was once associated with overindulgence of rich foods and wine, but in truth, anyone can get gout. [nm.org]
The formation of these mineralized masses can progressively erode bone and cartilage tissue and lead to chronic arthritis and joint deformity. Verywell / Emily Roberts Causes Similarly, genetics can play a part. [verywellhealth.com]
Having chronic gout means the disease has caused permanent damage to the affected joints, producing persistent inflammation, joint deformity, and extensive deposits of crystallized uric acid (tophi). [columbiadoctors.org]
Chronic symptoms such as joint deformity and limitation of motion in affected joints may occur if several attacks of gout occur each year. Uric acid deposits called tophi develop in cartilage tissue, tendons, and soft tissues. [mountsinai.org]
Surgery may be required to excise or drain infected or ulcerated tophi, to correct joint deformities, or to improve joint function. [medical-dictionary.thefreedictionary.com]
Arthritic, rheumatic and autoimmune disorders, such as rheumatoid arthritis and osteoporosis, are common conditions treated by rheumatologists. [nm.org]
Lupus Multiple sclerosis Osteoarthritis Osteoporosis Polymyositis Psoriatic arthritis Rheumatic fever Rheumatoid arthritis Scleroderma Type 1 diabetes [uvahealth.com]
[…] recognized for its dedication to advancing knowledge and translating research findings into more effective diagnosis and treatment of patients with rheumatic diseases such as rheumatoid arthritis, gout, lupus (systemic lupus erythematosus, or SLE), osteoporosis [uabmedicine.org]
Osteoarthritis in the big toe (Hallux valgus or hallux rigidus) or fingers (Heberdenske knuts) Less acute symptoms Do not expect high uric acid in blood test X-rays indicate osteoarthritis Joint injury caused by another disease Often in feet Stress fracture at osteoporosis [bindevevssykdommer.no]
A short course of steroid tablets often provides relief, but they can't be used long-term in high doses as they cause side effects, including: weight gain thinning of the bones ( osteoporosis ) easy bruising muscle weakness Corticosteroids can also be [nhsinform.scot]
Joints joint effusion (earliest sign) preservation of joint space until late stages of the disease an absence of periarticular osteopenia eccentric erosions the typical appearance is the presence of well-defined “punched-out” erosions with sclerotic margins [radiopaedia.org]
Joint effusion A traumatic right knee effusion. Note the swelling lateral to the kneecap as marked by the arrow. Specialty Orthopedics, rheumatology A joint effusion is the presence of increased intra-articular fluid. It may affect any joint. [en.wikipedia.org]
effusion; radiography results otherwise normal early in the disease View/Print Table Table 3 Accuracy of Key Findings in the Diagnosis of Acute Gout Findings Sensitivity (%) Specificity (%) LR LR Asymmetric swelling shown on a radiograph 16, 17 42 90 [aafp.org]
The medical term for excessive fluid in a joint is a "joint effusion." Gout frequently involves joints in the lower extremities. The classic location for gout to occur is the big toe (first metatarsophalangeal joint). [medicinenet.com]
Joint effusions and tophi can be well demonstrated by joint ultrasonography, and this is often helpful before joint puncture or to monitor the course of the disease (EL III) ( e16, e17 ). [ncbi.nlm.nih.gov]
The patient has unchanged arthralgia and the size and number of tophi remain the same as before treatment in spite of active treatment for 3 years. [ncbi.nlm.nih.gov]
(Redirected from Joint pain) Arthralgia Specialty Rheumatology Arthralgia (from Greek arthro-, joint -algos, pain) literally means joint pain. Specifically, arthralgia is a symptom of injury, infection, illness (in particular arthritis), or an allergic [en.wikipedia.org]
The most frequently reported adverse effects are diarrhea, back pain, headaches, and arthralgias. Also, patients should be monitored for thromboembolic events and increased hepatic transaminases. [clevelandclinicmeded.com]
Common AEs included back pain, headache, hypertension, arthralgia and gamma‐glutamyl transferase increase. [doi.org]
A detailed history and physical examination is often sufficient to form a diagnosis.
- Complete blood count
- Serum uric acid levels
- Serum electrolytes
- Serum creatinine
The imaging techniques that currently have a role in the imaging of gout include conventional radiography, ultrasound, computed tomography, dual energy computed tomography, magnetic resonance imaging and nuclear medicine .
Axial gouty arthropathy should be included in the differential diagnosis of chronic low back pain, mainly when several risk factors for gout are present . The presence of tophi is diagnostic. In other cases, a diagnosis can be based on physical examination and confirmed by lab tests.
Uricosuric agents are alternative therapies in patients with preserved renal function and no history of nephrolithiasis. [ncbi.nlm.nih.gov]
[…] gout in women should prompt a more detailed work up of enzyme deficiency; patients may complain of very mild attacks developing w/o provocation that abate w/o specific treatment; podagara : classic presentation of acute attack of first MTP joint; hand: nephrolithiasis [wheelessonline.com]
Shekarriz B, Stoller ML: Uric acid nephrolithiasis: current concepts and controversies. J Urol. 2002;168: 1307–14. MEDLINE 22. [doi.org]
However, some cases of back pain with radiculopathy secondary to this etiology have been reported. 56-year old male patient, with history of arterial hypertension, hypertriglyceridemia, obesity, glucose intolerance and alcohol abuse, diagnosed with gout [ncbi.nlm.nih.gov]
[…] obtained in less than half patients' male / female ratio ranging from 7:1 to 9:1 females with gout tend to be postmenopausal; pathophysiology predisposing conditions: common chronic diseases assoc w/ gout include alcoholism, obesity, hypertension, CAD, and hypertriglyceridemia [wheelessonline.com]
Uric Acid Increased
More uric acid increases your risk of having gout. Alcohol can also reduce the rate at which your body removes uric acid. Not everyone who drinks will develop gout. [healthline.com]
Gout, whilst in principle considered to be well understood and simple to treat, often presents diagnostic and management challenges, with evidence to suggest that it is often inadequately treated and poor compliance is a major issue .
Treatment of gout is mainly the use of nonsteroidal anti-inflammatory drugs, corticosteroids and colchicine. Colchicine is a potent anti-inflammatory drug that has a narrow therapeutic index. Indicated for treating gout and familial mediterranean fever, it inhibits mitosis by interfering with microtubule formation and arresting cell division . Analgesics may be prescribed to relieve pain. For prophylaxis, xanthine oxidase inhibitors like Allopurinol and Febuxostat may be given.
The natural course of gout has 4 stages. First is asymptomatic hyperuricemia which mostly occurs near puberty in males and after menopause in females. After a few years, the second stage, acute gouty arthritis, occurs. This stage is characterized by sudden, excruciating pain, usually in just one joint; 50% occur in the first metatarsophalengeal joint . Eventually other joints become involved. This stage, if left untreated, may last for a few weeks after which gradual resolution occurs, called the asymptomatic intercritical stage.
Now the prognosis varies. The patient may have a second gout attack and progress to the fourth stage called chronic tophaceous gout. Or in some patients, the disease may completely resolve. Overall, with appropriate treatment, gout has a good prognosis.
Patients with gout have as much as 1000 times more uric acid in the body as unaffected individuals do and are almost twice (1.97 times) as likely to develop renal stones as healthy individuals are . They also are prone to develop metabolic syndrome which increases chances of diabetes. Other complications include urate nephropathy due to tophi production in the kidneys resulting in pyelonephritis, recurrent fractures, secondary infections and nerve damage.
The heritability of serum urate levels is estimated at 63% . Gout tends to run in families and several genes have been implicated like URAT1, GLUT9, ABCG2.
Although genetic factors have been strongly associated with hyperuricemia, environmental and other state-of-health factors are responsible for the majority of the gout burden in developed countries . Consumption of fructose-rich foods and beverages is associated with an increased risk of gout in both men and women . Other factors include anemia, obesity, renal insufficiency, cancer and hypertension.
Gout has a high prevalence and is estimated to affect 1-2% population of the United States, and is becoming more common .
It is more common in males.
Gout is more common in some races and rare in others. It is more common in African-Americans than in Whites.
- Overproduction of uric acid
Uric acid is the end product of purine metabolism. One of the pathways involved in purine metabolism is called the salvage pathway in which the enzyme hypoxanthine guanine phosphoribosyl transferase (HGPRT) plays an important role. If this enzyme is deficient, it may lead to increased production of uric acid by the de novo pathway, resulting in gout.
- Reduced excretion
Plasma levels of uric acid are kept within normal range by the four-part excretion system (filtration, reabsorption, secretion and post-secretory reabsorption) of the kidneys. 90% of the filtered urate is reabsorbed by the action of URAT1 gene. Decreased filtration and underexcretion is the primary cause behind gout.
- Acute arthritis
Central to the pathogenesis of the arthritis is precipitation of monosodium nitrate (MSU) crystals into the joints . The synovium is edematous, congested and filled with an inflammatory infiltrate.
- Chronic tophaceous arthritis
Tophi are the pathognomonic hallmark of gout. They are large aggregates of urate crystals surrounded by inflammatory cells and they may occur in joint cavities, articular cartilage, tendons, ligaments, even inside kidneys and skin. This subtype occurs due to repetitive precipitation of urate crystals in acute attacks.
Gout is defined as an arthritic condition resulting from the deposition of monosodium urate (MSU) crystals in and/or around joints, following long-standing hyperuricemia . It is a very common condition in both developing and developed countries, but fortunately, it can be easily managed.
Gout is a painful inflammatory condition that can affect a variety of joints, causes significant distress and is associated with a number of comorbidities.
Several genetic and environmental factors play a role in causing this disease. Whatever the underlying etiology, gout is primarily due to increased levels of uric acid in blood.
Symptoms include swelling, redness and pain in joints. The most commonly involved joint is of the big toe. Gradually, more joints become involved such as the rest of the toes, instep, ankle, knee, hip, wrist and elbow. In some cases, joints of the vertebrae also become involved.
Treatment includes dietery modifications, lifestyle changes, weight reduction and analgesic and anti-inflammatory medications. Gout can easily be managed.
- Bardin T, Richette P. Definition of hyperuricemia and gouty conditions. Curr Opin Rheumatol. 2014 Mar;26(2):186-91.
- Yang Q, Guo CY, Cupples LA, Levy D, Wilson PW, Fox CS. Genome-wide search for genes affecting serum uric acid levels: the Framingham Heart Study. Metabolism. Nov 2005;54(11):1435-41.
- Vitart V, Rudan I, Hayward C, Gray NK, Floyd J, Palmer CN, et al. SLC2A9 is a newly identified urate transporter influencing serum urate concentration, urate excretion and gout. Nat Genet. Apr 2008;40(4):437-42.
- Choi HK, Curhan G. Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study. BMJ. Feb 9 2008;336(7639):309-12.
- Chen LX, Schumacher HR. Gout: an evidence-based review. J Clin Rheumatol 2008 14 (5 Suppl): S55–62.
- Robbins and Cotran. Pathologic Basis of Disease. 8th ed. V Kumar, AK Abbas, N Fausto, JC Aster, et al, eds. Pa: Saunders Elsevier. Ch 26 p 1242-46.
- Bernad B, Narvaez J, Diaz-Torné C, Diez-Garcia M, Valverde J. Clinical image: corneal tophus deposition in gout. Arthritis Rheum. Mar 2006;54(3):1025
- Chowalloor PV, Siew TK, Keen HI. Imaging in gout: A review of the recent developments. Ther Adv Musculoskelet Dis. 2014 Aug;6(4):131-43.
- Cardoso FN, Omoumi P, Wieers G, Maldague B, Malghem J, Lecouvet FE, Vande Berg BC. Spinal and sacroiliac gouty arthritis: report of a case and review of the literature. Acta Radiol Short Rep. 2014 Sep 17;3(8):2047981614549269.
- Stromberg P, Wills BK, Rose SR. Gout exacerbation, weakness, hypotension--Dx? J Fam Pract. 2014 Aug;63(8):455-6.