Gout
See also in: Cellulitis DDx,Nail and Distal DigitAlerts and Notices
Important News & Links
Synopsis

Gout is caused by body fluid urate saturation complicated by deposition of monosodium urate crystals in tissues. Elevated uric acid levels can be caused by overproduction of uric acid from purine catabolism or insufficient excretion by the kidneys and are necessary but not sufficient for the development of gout. The deposition of urate crystals in tissues leads to inflammation and subsequent tissue damage. The most common sites involved are the skin and joints. Gout can present as acute gouty arthritis or chronic tophaceous gout. Patients may also develop uric acid nephrolithiasis.
The acute form of gout presents as a painful, swollen, warm, and erythematous joint, usually monoarticular, with the most common joints affected being the first metatarsophalangeal joint, ankle, foot, and knee. The pain can be debilitating. Flares can last days to weeks if untreated and can become more severe and more frequent over time.
Chronic tophaceous gout presents most commonly involving the ear but can also affect other soft tissues, articular structures, bursas, or tendons. Smooth or multilobulated nodules can ulcerate, leading to extrusion of a chalk-like substance. Rarely, urate bullae may develop. In uncontrolled chronic gout, there may be frequent acute attacks that lead to destructive arthritis and joint deformity.
Men aged 40-50 are most commonly affected. Other risk factors include renal insufficiency, obesity, increased alcohol consumption, medications (eg, diuretics), lymphomas, leukemias, tumor lysis syndrome, and hemolysis as well as lead exposure (eg, from illegally distilled liquor, or "moonshine"; known colloquially as "saturnine gout").
The acute form of gout presents as a painful, swollen, warm, and erythematous joint, usually monoarticular, with the most common joints affected being the first metatarsophalangeal joint, ankle, foot, and knee. The pain can be debilitating. Flares can last days to weeks if untreated and can become more severe and more frequent over time.
Chronic tophaceous gout presents most commonly involving the ear but can also affect other soft tissues, articular structures, bursas, or tendons. Smooth or multilobulated nodules can ulcerate, leading to extrusion of a chalk-like substance. Rarely, urate bullae may develop. In uncontrolled chronic gout, there may be frequent acute attacks that lead to destructive arthritis and joint deformity.
Men aged 40-50 are most commonly affected. Other risk factors include renal insufficiency, obesity, increased alcohol consumption, medications (eg, diuretics), lymphomas, leukemias, tumor lysis syndrome, and hemolysis as well as lead exposure (eg, from illegally distilled liquor, or "moonshine"; known colloquially as "saturnine gout").
Codes
ICD10CM:
M10.9 – Gout, unspecified
SNOMEDCT:
90560007 – Gout
M10.9 – Gout, unspecified
SNOMEDCT:
90560007 – Gout
Look For
Subscription Required
Diagnostic Pearls
Subscription Required
Differential Diagnosis & Pitfalls
Acute Gouty Arthritis:
Chronic Tophaceous Gout:
Best Tests
Subscription Required
Management Pearls
Subscription Required
Therapy
Subscription Required
Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
Subscription Required
References
Subscription Required
Last Reviewed:07/08/2018
Last Updated:06/19/2023
Last Updated:06/19/2023

Premium Feature
VisualDx Patient Handouts
Available in the Elite package
- Improve treatment compliance
- Reduce after-hours questions
- Increase patient engagement and satisfaction
- Written in clear, easy-to-understand language. No confusing jargon.
- Available in English and Spanish
- Print out or email directly to your patient
Upgrade Today
Gout
See also in: Cellulitis DDx,Nail and Distal Digit