Fast Five Quiz: Gout and Pseudogout

Herbert S. Diamond, MD

Disclosures

December 04, 2019

Untreated, the first attacks of gout resolve spontaneously within weeks. A history of intermittent inflammatory arthritis, in which the joints return to normal between attacks, is typical of crystalline disorders and is characteristic of gouty arthritis early in its course. The pattern of symptoms in untreated gout changes over time. The attacks can become more polyarticular, more proximal and upper-extremity joints become involved, and attacks tend to occur more frequently and last longer.

The spontaneous onset of excruciating pain, edema, and inflammation in the metatarsal-phalangeal joint of the great toe is highly suggestive of acute gouty arthritis. Podagra is the initial joint manifestation in around half of all gout cases and is eventually involved in the vast majority of cases. However, podagra is not synonymous with gout or pseudogout. It may also be observed in patients with many other types of arthritis, including sarcoidosis, gonococcal arthritis, psoriatic arthritis, and reactive arthritis.

Fever, chills, and malaise do not distinguish cellulitis or septic arthritis from crystal-induced arthritis because these illnesses can all produce these signs and symptoms. A careful history may uncover risk factors for cellulitis or septic arthritis, such as possible exposure to gonorrhea, a recent puncture wound over the joint, or systemic signs of disseminated infection.

Gout initially presents as polyarticular arthritis in a minority of patients. Although crystal-induced arthritis is most commonly monoarticular, polyarticular acute flares are not rare, and many different joints may be involved simultaneously or in rapid succession. Multiple joints in the same limb often are involved, as when inflammation begins in the great toe and then progresses to involve the midfoot and ankle. Elderly women, particularly women with renal insufficiency who are taking a thiazide diuretic, can develop polyarticular arthritis as the first manifestation of gout.

Read more about the presentation of gout and pseudogout.

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