musculoskeletal and connective tissue disorders
Gout
Introduction
Gout is a disorder caused by hyperuricemia (serum urate > 6.8 mg/dL [> 0.4 mmol/L]) that results in the precipitation of monosodium urate crystals in and around joints, most often causing recurrent acute or chronic arthritis. The initial attack (flare) of gout is usually monarticular and often involves the 1st metatarsophalangeal joint. Symptoms of gout include acute, severe pain, tenderness, warmth, redness, and swelling. Definite diagnosis requires identification of crystals in synovial fluid. Treatment of acute flares is with anti-inflammatory drugs. The frequency of flares can be reduced by regular use of nonsteroidal anti-inflammatory drugs (NSAIDs),colchicine, or both plus persistent lowering of the serum urate level below its saturation level (< 6.8 mg/dL [< 0.4 mmol/L) withallopurinol,febuxostat, or uricosuric drugs such asprobenecid. (See also Overview of Crystal-Induced Arthritides .) Gout is more common among men than women. Usually, gout develops during middle age in men and after menopause in women. Gout is rare in younger people but is often more severe in people who develop the disorder before age 30. Gout often runs in families. Patients with Metabolic Syndrome are at increased risk of gout. 