Acute Gout

Abstract

Gout is an inflammatory arthritis caused by the deposition of monosodium urate crystals in and around the tissues of joints. It is most frequently associated with hyperuricemia, which is defined as serum urate level of 6.8 mg per deciliter. Gout disease has two stages: acute and advanced or chronic gout. The first attack of gout typically happens later in life. In men the onset is usually between the fourth and sixth decades. In women the first episode frequently does not happen until even later in life. Classical signs and symptoms of a gouty attack include rapid development of warmth, swelling, erythema, and pain in the affected joint. The joint most commonly affected first by gout is the first metatarsophalangeal joint. Gold standard for diagnosis is synovial fluid analysis for negatively biofringent crystals. Treatment options for acute gout include anti-inflammatory medications, steroids delivered systemically or via localized intra-articular injection method, and uric acid-mediating medications. Most cases can be managed by primary care physicians, but more refractory cases with recurrent attacks should be evaluated by a rheumatologist.