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Clinical Manifestations and Diagnosis of Gout

Article information

J Korean Med Assoc. 2010;53(8):695-704
Publication date (electronic) : 2010 July 30
doi : https://doi.org/10.5124/jkma.2010.53.8.695
Jung Soo Song, MD
Department of Rheumatology, Chung-Ang University College of Medicine, Seoul, Korea.
Corresponding author: Jung Soo Song. drsong@cau.ac.kr
Received 2010 July 05; Accepted 2010 July 20.

Abstract

Gout is a medical condition usually characterized by recurrent attacks of acute inflammatory arthritis involving, most commonly, the big toe, ankle, or other joints of the foot resulting from responses to the deposition of urate crystals from extracellular fluids supersaturated with urate. Middle aged men who are obese and drink alcohol regularly are the most susceptible. It is considered a chronic and progressive disease. Chronic gout can also lead to deposits of hard lumps of uric acid in the tissues, particularly in and around the joints, and may cause joint destruction, decreased kidney function, and kidney stones. It is associated with metabolic syndrome including dyslipidemia, hypertension, hyperglycemia, and obesity. Gout is suspected when a patient reports a history of attacks of painful arthritis, particularly at the base of the toes. A confirmative diagnosis of gout requires demonstration of monosodium urate crystals in the synovial fluid, tophi, or tissues.

Keywords: Gout; Uric acid; Acute arthritis; Renal insufficiency; Metabolic syndrome

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Copyright © 2010 Korean Medical Association

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Figure 1

Figure 1

Activation of phagocyte by membrane-active crystals.

Figure 2

Figure 2

Factors affecting urate balance.

Figure 3

Figure 3

Acute gout attack presenting in the 1st metatarsophalangeal joint. Redness, swelling and severe tenderness on the affected joint are distinctive features.

Figure 4

Figure 4

Tohpi over the foot showing lumps of urate (arrows).

Figure 5

Figure 5

Monososodium urate crystals from tophus. Polarizing microscpoy shows needle shaped strong negative birefringent monosodium urate crystals. (×100)

Figure 6

Figure 6

Foot/ankle views on duel energy CT illustrating large tophaceous deposits at the first metatarsophalangeal joints and along the right Achilles tendon (arrowheads).