-IBIS-1.5.0-
tx
musculoskeletal system
gout
diagnoses
definition and etiology
definition:
Arthritis nodosa or uratica; is an inherited disorder of metabolism causing recurrent acute arthritis of the peripheral joints.
etiology:
A disorder of protein metabolism leading to hyperuricemic body fluids which cause deposition of crystals of monosodium urate in and around the joints and tendons.
Occurs more commonly in men.
signs and symptoms
signs and symptoms:
acute or chronic arthritis
crystalline sodium urate deposition in soft tissues and cartilage; these may produce nodules known as tophi
metatarsophalangeal joint of the big toe is the most commonly affected joint
x-ray signs include punched-out lesions in subchondral bone
lab findings:
raised blood uric acid level, can be drug-induced (normals are about < 7-8 mg/100 ml); aspirin will decrease uric acid levels to normal; often several determinations are necessary to get increased levels
only a third of patients with hyperuricemia have gout
increased occurrence of uric acid stones in urine
potential proteinuria prior to gout symptoms
consider underlying malignancy with uric acid >10 mg%
perform 24-hour urine uric acid
increased WBC and ESR during acute phase
uric acid crystals in joint effusions
course and prognosis
Attacks can last from a few days to weeks; symptom-free periods exist between attacks. Early diagnosis is helpful; gout can be controlled well and the prognosis is good. In advanced cases, secondary renal damage and joint damage is difficult to reverse.
differential diagnosis
Rheumatoid arthritis
Ankylosing spondylitis
Osteoarthritis
Infection
footnotes