Signs And Symptoms Of Gout

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Signs And Symptoms Of Gout

Gouty arthritis hits the patient without any warning. With foot gout usually only one joint is affected, most commonly the base of the big toe (metatarsophalangel joint) with big toe joint pain. Alternatively a knee, elbow, wrist or one of the joints in the hand is afflicted with gout. The overlying skin is discolored (red or purplish), often under tension from underlying swelling or an effusion and extremely tender to the point where even skin being touched by a bedsheet causes severe pain.

There might be an associated fever with chills and a feeling of intense sickness. The classical case of gout of the great toe (metatarsophalangeal joint) is called podagra in medical circles (Ref. 1). In industrialized countries the patient with an acute gouty arthritis attack is treated by a physician and then followed to prevent further attacks. This has now lead to a certain complacency among the population.

Signs and symptoms of gout
Signs or symptoms:	Comments:
acute joint pains	from deposits of uric acid crystals
high uric acid levels	serum uric acid levels exceed 7.0 mg/dL (or 0.41 mmol/L)
podagra	gout of great toe (metatarsophalangeal joint)
tophi around joints or in earlobes	"tophi" are uric acid crystals deposited in subcutaneous tissue or around joints
kidney stones	in 20% of gout patients
fever, chills, sickness	non specific reaction of vegetative system to kinins released by white blood cells
other contributing diseases worsen gout	diabetes, hypertension, kidney disease, cancer treated with chemotherapy all worsen gout
crippling joint stiffening	very rare now with appropriate therapy; common in Middle Ages in royalty ( e.g. Henry VIII-th )
gout more common in males	male to female ratio is 20:1

However, in less fortunate countries where poverty is abundunt, medicine might not reach these patients and after the initial gouty attack several more will likely follow with a rate of 2 or more per year.

Gout becomes chronic subsequently and all joints can get affected. The joints undergo erosions and severe deformities, which leads to severe losses of range of motion with resulting stiffness of the joints.

Urate is deposited in the walls of tendon sheaths and bursae. They are called tophi and usually occur on hands, feet and around the outside (extensor side) of the elbow joints. If the tophi get big enough they can erupt and discharge the chalky content of urate crystals (Ref. 2).

Only about 20% of patients with gout develop kidney stones with either uric acid or calcium oxalate stones. These patients often have concomitant other health problems such as high blood pressure, chronic kidney disease such as pyelonephritis or diabetic nephropathy. It is important that these patients are carerfully monitored so that their kidney function stabilizes and the uric acid level is brought into a normal range where further kidney deterioration is prevented.

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References:

1. The Merck Manual, 7^th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 55.

2. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999.

3. Goldman: Cecil Textbook of Medicine, 21st ed.(©2000)W.B.Saunders

4. Ferri: Ferri's Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

5. Rakel: Conn's Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier