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Gout/pseudogout

Gout/pseudogout is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Uric acid deposition into tissues, affecting mainly middle-aged men and postmenopausal women:
    • Most common crystalline diseases
    • 4 phases:
      • Asymptomatic hyperuricemia (serum urate >7 mg/dL)
      • Acute gout
      • Intercritical gout: Quiet intervening periods
      • Tophaceous gout (up to 45% of cases)
    • Risk factors:
      • Age >40
      • Male/female ratio 2:1–6:1 <65 yr old; 1:1 ≥65 yr old
      • Hypertension
      • Use of loop or thiazide diuretics
      • High intake of alcohol, meat, seafood, and fructose-sweetened beverages
      • Obesity
    • Urologic deposition of uric acid calculi may cause renal dysfunction.
    • Associated with avascular necrosis and deforming arthritis
    • Most frequent in previously damaged joints, tissues:
      • Synovium
      • Subchondral bone
      • Bursae (olecranon, infrapatellar, prepatellar)
      • Achilles tendon
      • Extensor surface of the forearms, toes, fingers, ear
      • Rarely CNS or cardiac (valves)
  • Pseudogout: A disorder caused by calcium pyrophosphate crystal deposition:
    • Most common cause of acute monoarthritis >60 yr of age
    • Risk factors:
      • Hypercalcemia (e.g., hyperparathyroidism, familial)
      • Hemochromatosis; hemosiderosis
      • Hypothyroidism and hyperthyroidism
      • Hypophosphatemia, hypomagnesemia
      • Amyloidosis
      • Gout

Etiology

  • Deposition of monosodium urate crystals in tissues from supersaturated extracellular fluid owing to:
    • Underexcretion (most commonly) or excessive production of uric acid
    • Any rapid change in uric acid levels
      • Initiation or cessation of diuretics
      • Alcohol, salicylates, niacin
      • Cyclosporine
      • Lead acetate poisoning
      • Uricosurics or allopurinol
  • Pseudogout occurs secondary to excess synovial accumulation of calcium pyrophosphate crystals
  • Precipitants for both gout and pseudogout include minor trauma and acute illnesses:
    • Surgery, ischemic heart disease

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Citation

Rosen, Peter, et al., editors. "Gout/pseudogout." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307683/all/Gout_pseudogout.
Gout/pseudogout. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307683/all/Gout_pseudogout. Accessed April 23, 2019.
Gout/pseudogout. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307683/all/Gout_pseudogout
Gout/pseudogout [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307683/all/Gout_pseudogout.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Gout/pseudogout ID - 307683 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307683/all/Gout_pseudogout PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -