Gout

Definition

Gout is a form of inflammatory arthritis caused by deposition of monosodium urate crystals in joints and soft tissues, triggered by hyperuricemia. It presents with sudden severe joint pain, most often in the first metatarsophalangeal joint (podagra).

Risk Factors

• High-purine diet: organ meats, anchovies, sardines, shellfish, red meat
• Alcohol (especially beer)
• Obesity
• Diuretics (thiazides), low-dose aspirin
• Renal impairment
• Male sex, advancing age

Signs and Symptoms

Acute attack: Sudden warm, red, swollen, exquisitely tender joint (especially big toe). Chronic tophi, such as nodular deposits on ears, fingers, elbows.

Treatment

• Acute: NSAIDs, colchicine, corticosteroids
• Prophylaxis: Allopurinol or febuxostat (xanthine oxidase inhibitors); probenecid (uricosuric)
• Dietary modifications and fluid intake ≥ 2 L/day
• Do NOT start allopurinol during an acute attack

NCLEX Relevance

Diet low in purines; increase fluids. Classic cue: podagra (big toe pain).