Clinical Manifestations and Diagnosis of Gout

통풍의 증상과 진단

  • Lee, Eun-Bong (Department of Internal Medicine, Seoul National University College of Medicine)
  • 이은봉 (서울대학교 의과대학 내과학교실)
  • Published : 2011.03.01

Abstract

Gout is one of the most common inflammatory arthritidies in men and postmenopausal women. It causes recurrent and severe pain in the affected joints, especially in the first metatarsophalangeal joint. The stages of gout are divided into asymptomatic hyperuricemia, acute intermittent arthritis with intercritical period and chronic tophaceous gout. It also affects kidney and causes nephrolithiasis and urate nephropathy. Gout can be diagnosed by confirming monosodium urate crystals in the joint fluid through polarizing microscope. In some cases, clinical diagnosis can be made based on the typical features of the attacks. Differential diagnosis from infectious arthritis is important.

Keywords

References

  1. Becker MA, Jolly M. Hyperuricemia and associated diseases. Rheum Dis Clin North Am 2006;32:275-293. https://doi.org/10.1016/j.rdc.2006.02.005
  2. Schlesinger N. Diagnosing and treating gout: a review to aid primary care physicians. Postgrad Med 2010;122:157-161. https://doi.org/10.3810/pgm.2010.03.2133
  3. Gutman AB. Gout and gouty arthritis. In: Beeson PB, McDermott W, eds. Textbook of Medicine. 12th ed. Philadelphia: Saunders, 1958:595.
  4. Grundy SM, Hansen B, Smith Sc Jr, Cleeman JI. Clinical management of metabolic syndrome: report of the American heart association national heart, lung, and blood institute American diabetes association conference on scientific issues related to management. Circulation 2004;109:551-556. https://doi.org/10.1161/01.CIR.0000112379.88385.67
  5. Vazquez-Mellado J, Garcia CG, Vazquez SG, et al. Metabolic syndrome and ischemic heart disease in gout. J Clin Rheumatol 2004;10:105-109. https://doi.org/10.1097/01.rhu.0000129082.42094.fc
  6. Kahn HA, Medalie JH, Neufeld HN, Riss E, Goldbourt U. The incidence of hypertension and associated factors: the Israel ischemic heart disease study. Am Heart J 1972;84:171-182. https://doi.org/10.1016/0002-8703(72)90331-6
  7. Ward HJ. Uric acid as an independent risk factor in the treatment of hypertension. Lancet 1998;352:670-671. https://doi.org/10.1016/S0140-6736(05)60816-1
  8. Tomita M, Mizuno S, Yamanaka H, et al. Does hyperuricemia affect mortality? A prospective cohort study of Japanese male workers. J Epidemiol 2000;10:403-409. https://doi.org/10.2188/jea.10.403
  9. Puig JG, Michan AD, Jimenez ML, et al. Female gout: clinical spectrum and uric acid metabolism. Arch Intern Med 1991; 151:726-732. https://doi.org/10.1001/archinte.1991.00400040074016
  10. Burack DA, Griffith BP, Thompson ME, Kahl LE. Hyperuricemia and gout among heart transplant recipients receiving cyclosporine. Am J Med 1992;92:141-146. https://doi.org/10.1016/0002-9343(92)90104-J
  11. Howe S, Edwards NL. Controlling hyperuricemia and gut in cardiac transplant recipients. J Musculoskel Med 1995;12:15-24.
  12. Beck LH. Requiem for gouty nephropathy. Kidney Int 1986;30: 280-287. 13. Logan JA, Morrison E, McGill PE. Serum uric acid in acute gout. Ann Rheum Dis 1997;56:696-697.
  13. Logan JA, Morrison E, McGill PE. Serum uric acid in acute gout. Ann Rheum Dis 1997;56:696-697.
  14. Wallace SL, Robinson H, Masi AT, Decker JL, McCarty DJ, Yu TF. Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum 1977;20:895-900. https://doi.org/10.1002/art.1780200320
  15. Edwards NL. Clinical gout. In: Hochberg MC, Silman AJ, Solen JS, Weinblat ME, Weisman MH, eds. Rheumatology. 5th ed. Philadelphia: Elsevier, 2011:1859-1865.