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Maya Mattar, MD
09/15/2014
Gout
Epidemiology
Nearly half of all gout pts have difficulty in Near doubling of claims cost for Rx, sick leave, short
recreation & other QOL activities, but some will term disability and workman’s comp in gout vs non-
also have difficulty with even basic activities of gout pts ($6970 vs $3705)
daily living
Higher rate of all-cause mortality in those with More absence days per year and lower mean
gout vs without annual productivity
• Tophi are frequently seen in:
• Helix of the ear
• Over the olecranon processes
• On the Achilles tendons
• Within and around the toe or finger joints
• Around the knees, and within the pre-patellar bursae
• Spinal involvement can lead to nerve root or cord compressionand might also
mimic epidural infection
• Median nerve, which leads to carpal tunnel syndrome
• Rare locations: eyes,breast,vocal cords,heart,and colon
Lancet. 2010 Jan 23;375(9711):318-28. doi: 10.1016/S0140-6736(09)60883-7
Diagnosis (EULAR recs)
• A typical presentation of gout is highly suggestive of crystal inflammation,
although not specific for gout
• Identification of MSU crystals in synovial fluid or tophus aspirates allows a
definitive diagnosis of gout
• Gout and sepsis can coexist, so gram stain and culture of synovial fluid
should still be done when septic arthritis is even if MSU crystals are
identified
• Serum uric acid concentrations do not confirm or exclude gout because
many people with hyperuricemia do not develop gout, and during acute
attacks serum concentrations might be within the normal range in a third
of patients
• Radiographs useful for differential diagnosis and might show typical
features in chronic gout, but are not useful for confirmation of
diagnosis of early or acute gout
• Risk factors for gout and associated comorbidity should be assessed,
including features of metabolic syndrome (obesity, hyperglycemia,
hyperlipidemia, and hypertension)