Gout history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The classic picture of an acute gouty attack, is sudden, excruciating, unexpected and burning pain. There will also be swelling, redness, warmth, and stiffness in the joint. In approximately 75% of first episodes, gout usually attacks the big toe.

History and Symptoms

In 1683, Sir Thomas Sydenham (who was himself a sufferer of gout), wrote a classic and colorful description of a gouty attack as:

“The victim goes to bed and sleeps in good health. About 2 o’clock in the morning, he is awakened by a severe pain in the great toe; more rarely in the heel, ankle or instep. This pain is like that of a dislocation, and yet the parts feel as if cold water were poured over them. Then follows chills and shiver and a little fever. The pain which at first moderate becomes more intense. With its intensity the chills and shivers increase. After a time this comes to a full height, accommodating itself to the bones and ligaments of the tarsus and metatarsus. Now it is a violent stretching and tearing of the ligaments– now it is a gnawing pain and now a pressure and tightening. So exquisite and lively meanwhile is the feeling of the part affected, that it cannot bear the weight of bedclothes nor the jar of a person walking in the room.”

The presenting history and the clinical features of the disease have not changed much, and are the same as of today.

  • Gout usually affects men aged 40 years and over, and women over 65 years. 21205285
  • In a typical presentation, gout reveals itself for the first time as an acute episode of inflammation (flare), usually monoarticular, affecting the foot or ankle. 10.1001/jama.1941.02820060001001
  • Involvement of the first metatarsophalangeal joint (“podagra”) is typical and occurs in 56-78% of first attacks. The mid-foot, ankle, knee, finger joints, wrist, and elbow are also commonly affected. 21569453
  • The flares often occur at night-time, causing the patient to wake up from sleep due to severe pain, which is throbbing or burning in nature, and is associated with extreme joint tenderness. 25777045 25504842
  • Triggers to these attacks include hospitalization due to acute medical/surgical illness, dehydration, diuretic use, alcohol intake and purine-rich foods. 22648933 16945617  24054179
  • The inflammatory process reaches its peak intensity within 12-24 hours, and is associated with joint swelling and redness. 16707533. After this, the signs and symptoms subside with complete resolution in 1–2 weeks. 16707533
  • If hyperuricemia is left untreated, a second flare often occurs within two years. The inflammatory episodes become increasingly frequent, prolonged, and may affect other joints as well (polyarticular flares). 24473446 27112094
  • With repeated flares, the disease advances to chronic tophaceous gout which is often polyarticular, associated with chronic pain, and clinically evident crystal deposits (tophi) in soft tissues (figure 1). 224473446 21288096. The tophi, usually found in the hands, elbows, and feet, are typically pain free but can become acutely inflamed.
  • Tophaceous gout can also present atypically without any previous flares. Tophi can also be found in unusual locations such as the eye, nose, spine, and viscera. 1558451 22522111

References



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