What is Gout?

Gout is a condition that most commonly presenting in men over the age of thirty and is caused by high levels of urate in the blood leading to the deposition of uric acid crystals in soft tissue, joints, and bone. This can lead to acute gout flares characterized by inflammation and arthritis of a joint or less commonly, multiple joints. Over time, this condition can progress to a state of chronic gouty arthritis due to the development of tophi, solid uric acid crystals, in soft tissue. 

What are the symptoms of Gout?

Gouty flares are characterized by inflammation and arthritis of one or more joints. Gouty flares most commonly occur in the big toe but may occur in any joint. The joint is typically very painful and may be swollen, red, warm, and stiff. Flares usually last between a few days and a few weeks. Between flares, patients are considered to be in an intercritical state and are most often asymptomatic.

What are some precipitating factors to an acute flare? 

  • Ingestion of purine-rich foods such as alcohol, liver, and seafood
  • Medications (ex: diuretics, ACEI, ARB, pyrazinamide, ethambutol, aspirin

How is Gout diagnosed?

  • Preferred method – Synovial fluid analysis via arthrocentesis 
  • Blood tests – may show elevated neutrophil count, ESR, and CRP
  • Serum urate level 2 or more weeks after an acute flare
  • Imaging such as XRAY, MRI, ultrasound, or dual-energy CT

What are the differential diagnoses for Gout?

  • Septic arthritis
  • Trauma
  • Calcium pyrophosphate crystal deposition disease 
  • Cellulitis 

How is Gout treated? 

NSAIDs, such as indomethacin or Naprosyn, are the treatment of choice for an acute flare. Second-line treatment includes the use of colchicine. Steroids may be used in patients with severe renal disease or unresponsive to NSAIDs or colchicine. Allopurinol is the drug of choice to prevent gouty flares when the patient is in the intercritical phase but should not be used during an acute attack. In addition, patients should avoid medications and foods that may precipitate an acute attack. 

Posted in: Uncategorized