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| __NOTOC__ | | __NOTOC__ |
| '''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
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| {{Infobox_Disease |
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| Name = Gout |
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| Image = upper_tophaceous_gout.jpg |
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| Caption = Tophaceous Gout <br> (Image courtesy of Charlie Goldberg, M.D.)|
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| }}
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| {{Gout}} | | {{Gout}} |
| {{CMG}}; {{AE}} {{CZ}} | | {{CMG}} {{AE}} {{Shivam Singla}} |
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| {{SK}} Urate crystal arthropathy; uric acid crystal deposition in joint; gouty arthritis; podagra | | {{SK}} Urate crystal arthropathy; uric acid crystal deposition in joint; gouty arthritis; podagra |
| == [[Gout overview|Overview]] ==
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| == [[Gout historical perspective|Historical Perspective]] == | | ==[[Gout overview|Overview]]== |
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| == [[Gout pathophysiology|Pathophysiology]]== | | ==[[Gout historical perspective|Historical Perspective]]== |
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| == [[Gout differential diagnosis|Differentiating Gout from other Diseases]] == | | ==[[Gout pathophysiology|Pathophysiology]]== |
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| == [[Gout epidemiology and demographics|Epidemiology and Demographics]] == | | ==[[Gout differential diagnosis|Differentiating Gout from other Diseases]]== |
| | ==[[Gout epidemiology and demographics|Epidemiology and Demographics]]== |
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| == [[Gout risk factors|Risk Factors]] == | | ==[[Gout risk factors|Risk Factors]]== |
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| == [[Gout screening|Screening]] == | | ==[[Gout screening|Screening]]== |
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| == [[Gout natural history, complications and prognosis|Natural History, Complications and Prognosis]] == | | ==[[Gout natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Diagnosis== | | ==[[Diagnosis]]== |
| | | [[Gout staging|Staging]] | [[Gout history and symptoms|History and Symptoms]] | [[Gout physical examination|Physical Examination]] | [[Gout laboratory tests|Laboratory Findings]] | [[Gout electrocardiogram|Electrocardiogram]] | [[Gout x ray|X Ray]] | [[Gout CT|CT]] | [[Gout MRI|MRI]] | [[Gout echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Gout other imaging findings|Other Imaging Findings]] | [[Gout other diagnostic studies|Other Diagnostic Studies]] |
| [[Gout history and symptoms|History and Symptoms]] | [[Gout physical examination|Physical Examination]] | [[Gout laboratory findings|Laboratory Findings]] | [[Gout x ray|X Ray]] | [[Gout ultrasonograpy|Ultrasonograpy]] |[[Gout CT|CT]] | [[Gout MRI|MRI]] | | ==[[Treatment]]== |
| | | [[Gout medical therapy|Medical Therapy]] | [[Gout surgery|Surgery]] | [[Gout primary prevention|Primary Prevention]] | [[Gout secondary prevention|Secondary Prevention]] | [[Gout cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Gout future or investigational therapies|Future or Investigational Therapies]] |
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| {| class="wikitable" align="right"
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| |+ Accuracy of diagnostic criteria for gout among patients who had [[synovial fluid]] analysis
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| <ref name="pmid19125136">{{cite journal| author=Malik A, Schumacher HR, Dinnella JE, Clayburne GM| title=Clinical diagnostic criteria for gout: comparison with the gold standard of synovial fluid crystal analysis. | journal=J Clin Rheumatol | year= 2009 | volume= 15 | issue= 1 | pages= 22-4 | pmid=19125136 | doi=10.1097/RHU.0b013e3181945b79 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19125136 }} </ref>
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| ! !! Criteria!!Sensitivity !! Specificity
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| | ARA (ACR)||6 of 12 criteria||align="center"| 70% ||align="center"| 79%
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| | Rome||2 of 4 criteria:<br/>• Painful joint swelling, abrupt onset, Clearing in 1-2 weeks initially<br/>• Serum uric acid: >7 in males; >6 in females<br/>• Presence of tophi<br/>• Urate crystals in synovial fluid or tissues||align="center"| 70% ||align="center"| 83%
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| | New York||2 of 5 criteria:<br/>• 2 attacks of painful limb joint swelling<br/>• Abrupt onset and remission in 1—2 weeks initially<br/>• First MTP attack<br/>• Presence of a tophus<br/>• Response to colchicine-major reduction in inflammation within 48 h||align="center"| 67% ||align="center"| 89%
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| |}
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| Several sets of diagnostic criteria exit (see table).<ref name="pmid19125136">{{cite journal| author=Malik A, Schumacher HR, Dinnella JE, Clayburne GM| title=Clinical diagnostic criteria for gout: comparison with the gold standard of synovial fluid crystal analysis. | journal=J Clin Rheumatol | year= 2009 | volume= 15 | issue= 1 | pages= 22-4 | pmid=19125136 | doi=10.1097/RHU.0b013e3181945b79 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19125136 }} </ref>
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| {| class="wikitable" align="right"
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| |+ The serum uric acid level during an attack of gout<ref name="pmid20625017">{{cite journal| author=Janssens HJ, Fransen J, van de Lisdonk EH, van Riel PL, van Weel C, Janssen M| title=A diagnostic rule for acute gouty arthritis in primary care without joint fluid analysis. | journal=Arch Intern Med | year= 2010 | volume= 170 | issue= 13 | pages= 1120-6 | pmid=20625017 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20625017 | doi=10.1001/archinternmed.2010.196 }} </ref><ref name="pmid19369457">{{cite journal |author=Schlesinger N, Norquist JM, Watson DJ |title=Serum urate during acute gout |journal=J. Rheumatol. |volume=36 |issue=6 |pages=1287–9 |year=2009 |month=June |pmid=19369457 |doi=10.3899/jrheum.080938 |url=http://www.jrheum.org/cgi/pmidlookup?view=long&pmid=19369457 |issn=}}</ref>
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| ! !! Sensitivity !! Specificity
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| | > 5.88 mg/dl<ref name="pmid20625017"/>|| align="center"|95%|| align="center"|53%
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| | ≥ 6 mg/dl<ref name="pmid19369457"/>||align="center"| 86% ||align="center"| ?
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| | ≥ 8 mg/dl<ref name="pmid19369457"/>|| align="center"|68% || align="center"|?
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| |}
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| A [[clinical prediction rule]] (link to online version<ref name="pmid26926810">{{cite journal| author=Sylvester JE, Leggit JC| title=Diagnostic Tool for Gout Without Need for Joint Fluid Aspiration. | journal=Am Fam Physician | year= 2016 | volume= 93 | issue= 4 | pages= 256-8 | pmid=26926810 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26926810 }} </ref>) found that the following predicted urate crystals by aspiration:<ref name="pmid20625017">{{cite journal| author=Janssens HJ, Fransen J, van de Lisdonk EH, van Riel PL, van Weel C, Janssen M| title=A diagnostic rule for acute gouty arthritis in primary care without joint fluid analysis. | journal=Arch Intern Med | year= 2010 | volume= 170 | issue= 13 | pages= 1120-6 | pmid=20625017 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20625017 | doi=10.1001/archinternmed.2010.196 }} </ref>
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| * Male
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| * Onset within one day
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| * Joint redness
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| * First metatarsaophalangeal joint
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| * Previous arthritis attack per patient
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| * History of hypertension or 1 or more [[cardiovascular disease]]s
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| * Serum [[uric acid]] level > 5.88 mg/dl
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| However, among patients with high scores, 20% did not have crystals. Only one of 381 patients had bacterial arthritis.
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| ==Treatment==
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| [[Gout medical therapy|Medical Therapy]] | [[Gout surgery|Surgery]] | [[Gout secondary prevention|Secondary Prevention]] | [[Gout cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Gout future or investigational therapies|Future or Investigational Therapies]] | |
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| ==Case Studies==
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| :[[Gout case study one|Case #1]]
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| ==Related Chapter==
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| * [[Pseudogout]]
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| ==External Links==
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| * {{cite web | title=Questions and Answers on Gout from NIAMS| url=http://www.niams.nih.gov/Health_Info/Gout/default.asp | title = Answers and Questions on Gout | publisher= U.S. [[National Institutes of Health]]—[[National Institute of Arthritis and Musculoskeletal and Skin Diseases]] |date=September 28th, 2007 | accessdate=2007-08-28}}
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| * {{cite web | title=Coffee Consumption and Reduced Gout Risk | url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17530645 | work= Drinking coffee reduces risk of gout in middle age men | publisher= U.S. [[National Institutes of Health]] | accessdate=2007-05-25}}
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| {{Diseases of the musculoskeletal system and connective tissue}}
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| [[Category:Arthritis]]
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| [[Category:Rheumatology]]
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| [[Category:Disease]]
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| [[Category:Primary care]]
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| {{WH}}
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| {{WS}}
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| [[ar:نقرس]]
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| [[bg:Подагра]]
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| [[cs:Dna]]
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| [[da:Gigt]]
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| [[de:Gicht]]
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| [[es:Gota (enfermedad)]]
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| [[eo:Podagro]]
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| [[fa:نقرس]]
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| [[fr:Arthrite goutteuse]]
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| [[io:Kiragro]]
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| [[id:Gout]]
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| [[it:Gotta]]
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| [[he:שיגדון]]
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| [[lb:Giicht]]
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| [[ms:Gout]]
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| [[nl:Jicht]]
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| [[ja:痛風]]
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| [[no:Urinsyregikt]]
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| [[pl:Dna moczanowa]]
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| [[pt:Gota (doença)]]
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| [[ru:Подагра]]
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| [[sk:Dna]]
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| [[sr:Гихт]]
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| [[fi:Kihti]]
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| [[sv:Gikt]]
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| [[te:గౌటు]]
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| [[tr:Gut hastalığı]]
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| [[zh:痛风]]
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