Gout (cont.)
What are symptoms of gout?
The small joint at the base of the
big toe is the most common site of an acute gout attack of arthritis. Other joints that can be affected
include the ankles, knees, wrists, fingers, and elbows. Acute gout attacks are
characterized by a rapid onset of pain in the affected joint followed by warmth,
swelling, reddish discoloration, and marked tenderness. Tenderness can be
intense so that even a blanket touching the skin over the affected joint can be
unbearable. Patients can develop fever with the acute gout attacks. These
painful attacks usually subside in hours to days, with or without medication. In
rare instances, an attack can last for weeks. Most patients with gout will
experience repeated attacks of arthritis over the years.
Uric-acid crystals can deposit in tiny
fluid-filled sacs (bursae) around the joints. These urate
crystals can incite inflammation in the bursae leading to pain
and swelling around the joints, a condition called bursitis. In
rare instances, gout leads to a more chronic type of joint
inflammation which mimics rheumatoid arthritis.
In chronic (tophaceous) gout, nodular
masses of uric acid crystals (tophi) deposit in different soft
tissue areas of the body. Even though they are most commonly
found as hard nodules around the fingers, at the tips of the
elbows, and around the big toe, tophi nodules can appear anywhere
in the body. They have been reported in unexpected areas such as
in the ears, vocal cords, or (rarely) around the spinal cord!
How is gouty arthritis diagnosed?
Gout is suspected when a patient reports a
history of repeated attacks of painful arthritis at the base of
the toes. Ankles and knees are the next most commonly involved
joints in gout. Gout usually attacks one joint at a time, while
other arthritis conditions, such as systemic lupus and rheumatoid
arthritis, usually attack multiple joints simultaneously.
The most
reliable test for gout is finding uric-acid crystals in the joint
fluid obtained by joint aspiration (arthrocentesis). Arthrocentesis is a common
office procedure performed under local anesthesia. Using sterile
technique, fluid is withdrawn (aspirated) from the inflamed
joint, using a syringe and needle. The joint fluid is then
analyzed for uric-acid crystals and for infection. Shiny,
needle-like uric-acid crystals are best viewed with a polarizing
microscope. The diagnosis of gout can also be made by finding
these urate crystals from material aspirated from tophi nodules
and bursitis fluid.
Some patients with a classic history and
symptoms of gout can be successfully treated and presumed to have gout without undergoing
arthrocentesis. However, establishing a firm diagnosis is still
preferable since other conditions can mimic gout. These include
another crystal-induced arthritis called pseudogout, psoriatic
arthritis, rheumatoid arthritis, and even infection.
X-rays can sometimes be helpful, and may show
tophi-crystal deposits and bone damage as a result of repeated
inflammations. X-rays can also be helpful for monitoring the effects of chronic gout on the joints.
Next: How is gout treated? »
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