Gout

Definition: Results from precipitation of monosodium urate crystals in a joint space.
Diagnosis
-H&P.
-Definitive diagnosis: Joint aspiration of synovial fluid, examination under polarized light microscopy to identify negatively birefringent uric acid crystals.
-Arthrocentesis strongly recommended when possible.
–Validated diagnostic rule for gout (when arthrocentesis not feasible).
-DDx:
-R/o Septic arthritis.
Treatment
–Acute and Chronic Gout Pharmacotherapy.
-To prevent joint damage from gout, uric acid levels should be lowered by medication to < 6.
–Dietary changes to decrease the risk of gout flares

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-Most commonly affected joint is the first metatarsophalangeal (MTP) joint followed by the knee.

Important Gout links and Pearls

• Gout and MTP joint arthrocentesis.
• “Even a prior hx of gout or pseudogout doesn’t rule out the possibility of septic arthritis. In fact, septic arthritis is more common in patients w/ a hx of crystal-induced arthritis. Septic arthritis must be diagnosed and treated promptly, because irreversible damage can occur within 4-6 hours and the joint can be completely destroyed within 24-48 hours.”
• Diuretics (loops and thiazides) cause hyperuricemia. Thiazides are relatively contraindicated in patients with gout.

http://www.aafp.org/afp/2014/1215/p831.html

https://emedicine.medscape.com/article/329958-workup