Presentation
Rarely, gouty arthritis may present with effusion containing thick, milky white fluid. We report a case of gouty arthritis, describing cytologic features of the urate milk. [ncbi.nlm.nih.gov]
Discussion The initial presentation of our patient with multiple joint pain and swelling with neck stiffness and high-grade fever is an uncommon presentation of gouty arthritis. [jim.bmj.com]
Entire Body System
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Family History of Gout
Neither patient had a family history of gout or inherited renal disease. [ncbi.nlm.nih.gov]
history of gout, alcohol use, obesity, thiazide administration, lead Aspirate: grossly white gray and granular; strongly negative birefringent needle shaped crystals under polarized light; foreign body giant cells Clinical images Images hosted on other [pathologyoutlines.com]
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]
You are more likely to get gout if you: Have a family history of gout. Have had an organ transplant. Are a man. Are an adult. Are overweight. Drink alcohol. Eat a lot of foods rich in purines. Have been exposed to lead. [niams.nih.gov]
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Chills
Chills and rigors may accompany. Fever Apart from the common symptoms attributed to the inflammation, systemic symptoms such as fever can sometimes occur as a result from a severe form inflammation. Chills and rigors may accompany. [medicaljoyworks.com]
Reactions can include fever, heart rate increase and chills. The severe joint pain can occur sporadically and last for days. Yet, in some cases, the attacks can last for months. [drlox.com]
Then follows chills and shiver and a little fever. The pain which at first moderate becomes more intense. With its intensity the chills and shivers increase. [hopkinsarthritis.org]
Other joints involved (in decreasing order of frequency) include insteps, knees, wrists, fingers, and olecranon bursae. 12 Systemic symptoms and signs of fatigue, fever, and chills may accompany the acute arthritis. [ajmc.com]
Then follows chills and shivers, and a little fever... [web.archive.org]
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Pseudotumor
Inflammatory pseudotumor (IPT) of the liver is a rare benign lesion of unknown etiology and is often accompanied by fever. [ncbi.nlm.nih.gov]
Skin
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Gouty Tophus
The case presented here indicates the possibility of pathologic rupture of the ACL associated with gouty tophus infiltration of that ligament. Level of evidence IV. [ncbi.nlm.nih.gov]
Rao et al. [ 3 ] reported a case of gouty tophus with normal serum uric acid level. Measurement of serum uric acid is of limited help in the diagnosis of chronic tophaceous gout. [omicsonline.org]
This review discusses imaging modalities and highlights ultrasongraphic evidence suggesting a significant relationship between the presence of the gouty tophus and bone erosions as well as the frequent presence of persistent low-grade inflammation in [ard.bmj.com]
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]
Musculoskeletal
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Arthritis
[…] and 29 with gouty arthritis. [ncbi.nlm.nih.gov]
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Joint Swelling
Joint swelling, synovial cytokine production and histopathology were determined after 4 h. [ncbi.nlm.nih.gov]
Restricted movements of the joint Due to severe pain Restricted movements of the joint Due to severe pain Joint swelling Due to the inflammation triggered by the monosodium urate crystal deposition in joints. [medicaljoyworks.com]
This is a case report of an unusual presentation of acute gouty arthritis that involved multiple joints on initial presentation, including migratory arthritis, joint swelling, neck stiffness, and high-grade fever. [jim.bmj.com]
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 [dx.doi.org]
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Joint Effusion
MRI revealed capsular thickening in 19 patients, bone marrow edema (BME) in 15, soft tissue edema (STE) in 20, joint effusion in 21, bone erosions in 17, cartilaginous erosions in 4, and tenosynovitis in 9 cases. [ncbi.nlm.nih.gov]
The early radiological signs of gout are joint effusion and periarticular edema, caused by the deposition of the nonopaque crystals within the synovial and cartilaginous tissues. 5,6,7 Radiographic examination eventually reveals a classic ‘punched-out [appliedradiology.com]
It often presents with painful joint effusion and commonly is diagnosed either by clinical examination, elevated serum uric acid level or cytological examination of an effusion. [omicsonline.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.[1] It may affect any joint. [en.wikipedia.org]
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Joint Deformity
Joint deformity Recurrent acute attacks can cause chronic tophaceous gout. [medicaljoyworks.com]
JM Co offers medical advice to 65-year-old Ricardo Javier who suffers from a chronic gouty arthritis that led to joint deformities in his hands and feet. For more videos: For News Update, visit: Check out our official social media accounts: ... [youtube.com]
Without treatment, joint deformation and limitation of movement can occur. [drlox.com]
Chronic attacks can be destructive causing resorption and erosion of the bone, and can potentially cause joint deformities. Chronic tophaceous gout is induced by repeated attacks of gout over many years leading to tophies formation. [eldersarthritis.com]
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]
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Knee Pain
A 65-year-old male with a history of gout presented with bilateral knee pain. His radiographic imaging was negative for gouty tophi, and he elected to undergo left total knee arthroplasty. [ncbi.nlm.nih.gov]
One month prior to admission, he presented with right knee pain and swelling. Blood cultures grew S. epidermidis. He was treated for presumed septic arthritis complicated by MSSE bacteremia. [the-rheumatologist.org]
CPPD can have symptoms resembling that of gout and can also occur concomitantly in up to 40% of patients with gout. 9 Our patient who was on long duration of treatment for gouty arthritis presented to our clinic with nonspecific knee pain and an incidental [appliedradiology.com]
pain is not particularly common, it should always be considered with any sudden incidence of knee pain associated with swelling and redness. [knee-pain-explained.com]
Workup
Gout and Pseudogout Workup. Available online at . Accessed 6/20/2017. National Institute of Arthritis and Musculoskeletal and Skin Disease. 2016. Questions and Answers about Gout. Available online at . Accessed 6/20/2017. [labtestsonline.org]
"Gout: Differential Diagnoses & Workup – eMedicine Rheumatology". Medscape. 2019-01-17. Archived from the original on 2010-07-25. "Gout and Pseudogout: Differential Diagnoses & Workup – eMedicine Emergency Medicine". Medscape. 2019-01-17. [en.wikipedia.org]
Classic radiographic findings are highly suggestive (see Workup ). [emedicine.com]
X-Ray
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Nephrolithiasis
renal insufficiency, urate nephropathy, nephrolithiasis), and cardiovascular events (i.e., myocardial infarction, heart failure, ischemic stroke). [ncbi.nlm.nih.gov]
The association between gout and nephrolithiasis in men: The Health Professionals' Follow-Up Study. Kidney Int. 2003;64:1022-1026. Schlesinger N, Detry MA, Holland BK, et al. Local ice therapy during bouts of acute gouty arthritis. [primeinc.org]
Asssociations Long term hyperuricemia results in uric acid crystals in the renal collecting system or urate crystals deposition in the renal medulla, which may lead to nephrolithiasis or urate nephropathy. [medicaljoyworks.com]
Uric acid nephrolithiasis occurs in 10–25% of patients with gout. [accesspharmacy.mhmedical.com]
Serum
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Uric Acid Increased
On follow-up, it was confirmed that as serum C3 level returned to normal, urinary excretion of uric acid increased and serum uric acid level decreased, thereby resolving the burning pain of the left big toe. [ncbi.nlm.nih.gov]
Avoidance of uric acid-increasing drugs (e.g., diuretics, aspirin in low doses, cyclosporine, ethambutol). Alcohol consumption (especially beer!). Strive for normal weight. [lecturio.com]
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]
Treatment
However, differences in renal function between the treatment and no-treatment groups were not statistically significant in any of the identified studies. CONCLUSION: Very limited data are available on the treatment of HU in asymptomatic patients. [ncbi.nlm.nih.gov]
Prognosis
The Severe Gout of Emperor Charles V diff dx: gout attacks in the painful TKR pseudogout prognosis: arthritis remits completely and then recurs with increasing frequency; in a pt w/ h/o acute gout, there is an 86% occurance of recurrent acute attack 3 [wheelessonline.com]
"We know from clinical trials that if we give biologic therapies to patients at a very early stage in their diagnosis we can put the disease into remission, so having a means of being able to select patients with a poor prognosis brings us closer to a [telegraph.co.uk]
MRI Signal characteristics of gouty tophi are usually: T1: isointense T2 variable 4 the majority of lesions are characteristically heterogeneously hypointense T1 C (Gd): tophus often enhances Treatment and prognosis Acutely, gout can be managed with non-steroidal [radiopaedia.org]
What Is the Prognosis for Gout? The prognosis for gout is excellent if you are properly diagnosed and treated. [emedicinehealth.com]
Etiology
Inflammatory pseudotumor (IPT) of the liver is a rare benign lesion of unknown etiology and is often accompanied by fever. [ncbi.nlm.nih.gov]
The diagnosis of gout must therefore be considered in some detail.2 Gout is a disease of unknown etiology characterized chiefly by (1) arthritis, which is at first acute and recurrent, each attack being followed by complete symptomatic remission, but [jamanetwork.com]
The details of his illness and its possible etiology are reviewed. Inflammatory rheumatism was a descriptive term within which several modern diagnoses might be included. [dx.doi.org]
Epidemiology
Epidemiological data, serum uric acid level, and arthritis attacks were recorded at monthly follow-up visits. DECT of bilateral feet and ankles was performed at baseline and after 6 months of ULT. [ncbi.nlm.nih.gov]
The changing epidemiology of gout. Nat Clin Pract Rheumatol. 2007;3:443-9 2. Rho YH, Zhu Y, Choi HK. The Epidemiology of Uric Acid and Fructose. Semin Nephrol. 2011;31:410-9 3. Richette P, Bardin T. Gout. Lancet. 2010;375:318-28 4. [medsci.org]
Pathophysiology
In this review, we present a general overview of gouty arthritis including its pathophysiology, clinical presentations, diagnosis, predisposing factors and prophylactic therapy for preventing gouty arthritis flares. 2013 Chinese Orthopaedic Association [ncbi.nlm.nih.gov]
Pharmacotherapy: A Pathophysiologic Approach. 8th ed. . Accessed May 27, 2012. Recurrent painful attacks of acute arthritis with hyperuricemia and monosodium urate crystals in synovial fluid leukocytes. [accesspharmacy.mhmedical.com]
[…] of uric acid Radical dieting practices that involve starvation Secondary gout associated with drugs Secondary gout associated with other diseases: Diabetes Mellitus Hypertension Leukemia Myeloma Obesity Polycythemia Renal disease Sickle Cell Anemia Pathophysiology [rnpedia.com]
[…] and neutrophils followed by chronic gouty arthritis with tophi in joints and urate nephropathy Causes 2 - 5% of chronic joint disease Sites 50% have initial attack in first metatarsophalangeal joint; also ankles, heels, knees, wrists, fingers, elbows Pathophysiology [pathologyoutlines.com]
Prevention
OBJECTIVE: To systematically review available literature on treatment of hyperuricemia (HU) as a measure of preventing gouty arthritis, renal disease, or cardiovascular events in asymptomatic patients. [ncbi.nlm.nih.gov]