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2.1
Gouty Arthritis
Joint Inflammation in Gout

Images

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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

  • Weakness

    The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. [ncbi.nlm.nih.gov]

    Complex diseases Some have argued identifying genetic weak areas for complex diseases - known as single nucleotide polymorphisms (SNPs) - is not useful. [bbc.co.uk]

    […] or pain, numbness or tingling in the fingers or toes, unusual bleeding or bruising, severe diarrhea or vomiting, feeling weak or tired, increased infections, and pale or gray color of the lips, tongue, or palms of hands. [web.archive.org]

    The team discovered that an existing drug could treat a weakness that was produced by one of the faulty areas. [independent.co.uk]

  • Family History of Gout

    Neither patient had a family history of gout or inherited renal disease. [ncbi.nlm.nih.gov]

    and synovial membranes; on avgerage, a family 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 [wheelessonline.com]

    […] with hyperuricemia are age > 30 years, familial 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 [pathologyoutlines.com]

    Men, especially those between ages 40 and 50, are more likely to develop gout than women. Women rarely develop gout before menopause. You are more likely to get gout if you: Have a family history of gout. Have had an organ transplant. Are a man. [niams.nih.gov]

  • Chills

    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]

    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]

    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]

    When a person gets osteoarthritis, they do not experience chills and mild fever like people with gout can. Here are some other differences: Diagnosis Gout – imaging tests, drawing fluid from the swollen joint for analysis, blood tests. [belmarrahealth.com]

  • Fatigue

    Fibromyalgia may be associated with changes in muscle metabolism, such as decreased blood flow, causing fatigue and decreased strength. Others believe... ‏ [books.google.com]

    In addition to causing joint problems, rheumatoid arthritis can also affect your whole body with fevers and fatigue. Because it is a chronic disease, rheumatoid arthritis continues indefinitely and may not go away. [easydna.co.za]

    Fatigue is the first sign of RA and is usually experienced before the onset of other symptoms. Fatigue could be accompanied by depression or a feeling of ill health. [xcode.life]

    Commonly used daily for muscle fatigue and soreness resulting from exercise and physical activity, Phoenix KinetiCream is also used to relieve painful areas following injury or medical conditions that cause chronic pain. [phoenixbioperformance.com]

    Information from CDC and FDA on the Safety of Gardasil Vaccine". supplement to your biologics license application (BLA) for Human Papillomavirus Quadrivalent (Types 6, 11, 16 and 18) Vaccine, Recombinant (GARDASIL), to include arthralgia, myalgia, asthenia, fatigue [en.wikipedia.org]

Cardiovascular

  • Vascular Disease

    Potential role of sugar (fructose) in the epidemic of hypertension, obesity and the metabolic syndrome, diabetes, kidney disease, and cardio-vascular disease. Am J Clin Nutr 2007; 86: 899-906. 16. Choi HK, et al. [second-opinions.co.uk]

    A study published by the online journal Vascular Specialist in 2015 found that gout predicted an increased risk of any vascular event and of coronary heart disease and peripheral vascular disease. The risk was found to be higher in women, though. [livescience.com]

    Multivariate analysis showed that women with gout had a 25% increased risk for any vascular event compared with women without gout (hazard ratio [HR], 1.25) and increased risks for any coronary heart disease (HR, 1.25) and peripheral vascular disease [emedicine.medscape.com]

Musculoskeletal

  • Arthritis

    Local ice therapy during bouts of acute gouty arthritis. J Rheumatol. 2002;29:331-334. [primeinc.org]

    Gouty Arthritis Treatment Of all the possible types of arthritis gouty arthritis is the most favorable because it is very easy for a competent expert to cure this disease. [yourhealthyjoints.com]

    Part 2: therapy and antiinflammatory prophylaxis of acute gouty arthritis. Arthritis Care Res (Hoboken). 2012;64(10):1447-1461. PMID: 23024029 www.ncbi.nlm.nih.gov/pubmed/23024029. Liew JW, Gardner GC. [medlineplus.gov]

    Cases were defined as patients with gouty arthritis. Factors that are possibly associated with gouty arthritis and/or heart failure were evaluated. [ncbi.nlm.nih.gov]

  • 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]

    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]

  • Joint Effusion

    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]

    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]

    A significant rate of concordance was found between US and MRI results, for joint effusion (k=0.683, p Conclusion: The high correlation rate between the results of US and MRI have shown that in rheumatoid arthritis patients with knee joint involvement [thefreelibrary.com]

    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]

  • Joint Deformity

    The severe joint pain can occur sporadically and last for days. Yet, in some cases, the attacks can last for months. Without treatment, joint deformation and limitation of movement can occur. [drlox.com]

    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. [youtube.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]

    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]

  • Knee Pain

    We report a case of white, chalky MSU crystal deposition covering the articular surfaces of the knee as discovered by total knee arthroplasty. A 65-year-old male with a history of gout presented with bilateral knee pain. [ncbi.nlm.nih.gov]

    یورک ایسڈ کیا ہے اور کیوں ہوتا ہے۔ Basic Symptoms,Causes And Treatment Of Uric Acid Knee Pain Treatment at Home -How to Treat Knee Pain by Sachin Goyal (Hindi) Episode 06 जोड़ों का दर्द گنٹھیاکا مکمل علاج گنٹھیا والے مریض ضرور دیکھیں Want to REDUCE Your [nweb.live]

    If the knee suddenly becomes hot, painful, red and swollen, it is most likely due to Gout Knee. [knee-pain-explained.com]

    On the current presentation, the patient complained of fever of two days’ duration as well as left elbow and bilateral hand, knee and foot pain. He denied sick contacts, weight loss, night sweats, hemoptysis, abdominal pain, chest pain or dyspnea. [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]

Skin

  • 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]

    Malignant fibrous histiocytoma arising in a gouty tophus at the second metacarpophalangeal joint. J Plast Reconstr Aesthet Surg. 2006 ;59: 775 – 8. Google Scholar | Crossref | Medline | ISI 2. Gentili, A. The advanced imaging of gouty tophi. [doi.org]

    We present a case in which diagnosis of gout was made by fine needle aspiration of tophus. FNAC of gouty tophus is an easy alternative to synovial biopsy. It is simpler, easier and less painful. [omicsonline.org]

    It is the tophus eroding the underlying bone that is pivotal for the development of bone erosions in gouty arthritis. [ard.bmj.com]

Urogenital

  • Anuria

    The consequence is uric acid accumulation in the lumen of the tubules, which leads to oliguria, anuria and vomiting. Interstitial precipitations result in mild proteinuria and low-degree kidney insufficiency. [lecturio.com]

    Effects of long-term colchicine toxicity include agranulocytosis, thrombocytopenia, low white blood cell counts, aplastic anemia, alopecia, rash, purpura, vesicular dermatitis, kidney damage, anuria, peripheral neuropathy, and myopathy.[27] No specific [en.wikipedia.org]

Neurologic

  • Confusion

    Pseudogout has similar symptoms and is sometimes confused with gout. However, it is caused by calcium phosphate, not uric acid. [medlineplus.gov]

    Pseudogout has similar symptoms and is sometimes confused with gout. However, it is caused by calcium phosphate, not uric acid.often, gout first attacks your big toe. It can also attack ankles, heels, knees, wrists, fingers and elbows. [icd9data.com]

    The involvement of the shoulder and the spine, along with a history of travel and exposure to insect/mosquito bite, caused diagnostic confusion. [jim.bmj.com]

Workup

Gout and Pseudogout Workup. Available online at http://emedicine.medscape.com/article/329958-workup. Accessed 6/20/2017. National Institute of Arthritis and Musculoskeletal and Skin Disease. 2016. Questions and Answers about Gout. [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.medscape.com]

X-Ray

  • Nephrolithiasis

    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]

    Outcomes of interest included gouty arthritis, renal disease (i.e., renal insufficiency, urate nephropathy, nephrolithiasis), and cardiovascular events (i.e., myocardial infarction, heart failure, ischemic stroke). [ncbi.nlm.nih.gov]

    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]

    Uricosuric agents are alternative therapies in patients with preserved renal function and no history of nephrolithiasis. [aafp.org]

Serum

  • 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]

    Stones form due to increased uric acid excretion, acidic urine and substances decreasing uric acid solubility. Uric acid nephropathy exclusively develops at very high serum-uric acid levels. [lecturio.com]

    When your body breaks down purines, the process releases uric acid. 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

[…] can also be used for acute gouty arthritis but generally are reserved as the last treatment option because of their associated short- and long-term side effects. [primeinc.org]

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]

Outlook (Prognosis) Proper treatment of acute attacks and lowering uric acid to a level less than 6 mg/dL allows people to live a normal life. However, the acute form of the disease may progress to chronic gout if not treated adequately. [mountsinai.org]

"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]

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. [oadoi.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]

Various diagnostic criteria have been proposed for gout, depending on whether they are to be used in a clinical setting or for epidemiological surveys. 1 The criteria proposed by Bennett and Wood in 1968 2 are still helpful in routine clinical practice [dx.doi.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]

[…] 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]

Pharmacotherapy: A Pathophysiologic Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=7997829. Accessed May 27, 2012. [accesspharmacy.mhmedical.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]

You may not be able to prevent gout, but you may be able to avoid things that trigger symptoms. Taking medicines to lower uric acid can prevent progression of gout. Over time, your deposits of uric acid will disappear. [medlineplus.gov]

Includes a short video and details of symptoms, causes, diagnosis, treatment, complications and prevention. Gout Doctors answers to frequently asked questions about this disorder. [curlie.org]

To help prevent an attack from coming back, colchicine can be given once or twice a day. [emedicinehealth.com]

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