Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Nov 8 2023


  • summary
    • Gout is a form of inflammatory arthritis caused by intraarticular monosodium urate crystal deposition that typically presents with recurrent acute exacerbation of joint swelling and severe pain.
    • Diagnosis is made by joint aspiration and crystal analysis showing strongly negatively birefringent needle-shaped intracellular crystals.
    • Treatment for acute gout attacks is NSAIDs with chronic gout being treated with allopurinol and medical management to reduce uric acid. 
  • Epidemiology
    • Demographics
      • recurrent attacks seen in men from ages 40-60 years
    • Anatomic location
      • usually seen in lower limb
        • podagra (arthritis attacks of great toe)
      • crystal deposition as tophi
        • ear helix, eyelid olecranon, Achilles tendon
    • Risk factors
      • chemotherapy
  • Etiology
    • Forms
      • primary gout
        • an idiopathic disorder of nucleic acid metabolism that leads to hyperuricemia and deposition of monosodium urate crystals in joints (a purine breakdown product)
      • secondary gout
        • is associated with a disease with high metabolic turnover (psoriasis, hemolytic anemia, leukemia, chemotherapy)
    • Pathophysiology
      • dysfunctional nucleic acid metabolism causing hyperuricemia
      • deposition of monosodium urate crystals in synovium of joint
      • crystals lead to an inflammatory response activating
        • proteases
        • prostaglandins
        • leukotriene B4
        • free oxygen radicals
    • Associated conditions
      • renal stones
      • septic arthritis
        • the presence of uric acid crystals does not exclude septic arthritis
  • Presentation
    • Symptoms
      • pain in joint
      • can resemble septic arthritis
      • symptoms of renal stones
    • Physical exam
      • may have decreased range of motion due to pain
      • white toothpaste-like appearance of tophus aspirate
  • Imaging
    • Radiographs
      • recommended views
        • AP and lateral of affected joint
      • findings
        • may see punched out periarticular erosion with sclerotic overhanging borders
        • may see soft tissue crystal deposition (tophi)
  • Studies
    • Labs
      • serum uric acid
        • elevated uric acid is not diagnostic (80% of people with an elevated uric acid will never have a gout attack)
    • Crystal analysis
      • diagnosis made by joint aspiration and crystal analysis
      • monosodium urate (MSU) crystals are
        • thin, tapered, needle-shaped intracellular crystals
          • yellow when aligned parallel to red compensator
          • blue when aligned across the direction of polarization
        • strongly negatively birefringent
  • Treatment
    • Acute gout
      • indomethacin vs. colchicine
        • indications
          • first line of treatment
        • medications
          • indomethacin (indocin) 50mg tid
            • NSAID
            • inhibits phagocytosis
          • colchicine
            • indicated in acute attacks if patient has a history of peptic ulcers
            • inhibits inflammatory mediators
            • can be given intravenously
      • oral, intraarticular or IV glucocorticoid
        • indication
          • patient unable to take NSAID or colchicine
    • Chronic gout
      • allopurinol
        • indications
          • first line of treatment for chronic gout attack
        • medications
          • allopurinol is an xanthine oxidase inhibitor
      • colchicine
        • indications
          • for prophylaxis after recurrent attacks
          • up to 85% effective
1 of 24
1 of 12
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options