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Gout
B.J. Manaster, MD, PhD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Diagnostic Checklist

        TERMINOLOGY

        • Synonyms

          • Gouty arthritis, tophaceous gout
        • Definitions

          • Hyperuricemia, resulting in sodium urate crystal deposition in soft tissues and joints
            • Primary gout: Results from abnormalities in purine metabolism or from idiopathic ↓ renal excretion of urate
            • Secondary gout: Results from increased serum uric acid levels resulting from associated disorder
              • Neoplasms, lymphoproliferative disease
              • Chronic renal failure
              • Drug therapy (diuretics, ethanol, cytotoxics)
            • Saturnine gout: Results from chronic lead intoxication from either occult or occupational exposure or ingestion of moonshine

        IMAGING

        • General Features

          • Imaging Recommendations

            • Radiographic Findings

              • Ultrasonographic Findings

                • CT Findings

                  • MR Findings

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Microscopic Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    • Image Interpretation Pearls

                                      Selected References

                                      1. Girish G et al: Advanced imaging in gout. AJR Am J Roentgenol. 201(3):515-25, 2013
                                      2. Lumezanu E et al: Axial (spinal) gout. Curr Rheumatol Rep. 14(2):161-4, 2012
                                      3. Desai MA et al: Clinical utility of dual-energy CT for evaluation of tophaceous gout. Radiographics. 31(5):1365-75; discussion 1376-7, 2011
                                      4. Glazebrook KN et al: Identification of intraarticular and periarticular uric acid crystals with dual-energy CT: initial evaluation. Radiology. 261(2):516-24, 2011
                                      5. Konatalapalli RM et al: Gout in the axial skeleton. J Rheumatol. 36(3):609-13, 2009
                                      6. Cammalleri L et al: Rasburicase represents a new tool for hyperuricemia in tumor lysis syndrome and in gout. Int J Med Sci. 4(2):83-93, 2007
                                      7. Centers for Disease Control and Prevention (CDC): Projected state-specific increases in self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitations--United States, 2005-2030. MMWR Morb Mortal Wkly Rep. 56(17):423-5, 2007
                                      8. Choi HK et al: Prevalence of the metabolic syndrome in patients with gout: the Third National Health and Nutrition Examination Survey. Arthritis Rheum. 57(1):109-15, 2007
                                      9. Keith MP et al: Updates in the management of gout. Am J Med. 120(3):221-4, 2007
                                      10. Pascual E et al: Therapeutic advances in gout. Curr Opin Rheumatol. 19(2):122-7, 2007
                                      11. Perez-Ruiz F et al: Imaging modalities and monitoring measures of gout. Curr Opin Rheumatol. 19(2):128-33, 2007
                                      12. Reginato AM et al: Genetics and experimental models of crystal-induced arthritis. Lessons learned from mice and men: is it crystal clear? Curr Opin Rheumatol. 19(2):134-45, 2007
                                      13. Shah K et al: Does the presence of crystal arthritis rule out septic arthritis? J Emerg Med. 32(1):23-6, 2007
                                      14. Stamp LK et al: Emerging therapies in the long-term management of hyperuricaemia and gout. Intern Med J. 37(4):258-66, 2007
                                      15. Wise CM: Crystal-associated arthritis in the elderly. Rheum Dis Clin North Am. 33(1):33-55, 2007
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Diagnostic Checklist

                                            TERMINOLOGY

                                            • Synonyms

                                              • Gouty arthritis, tophaceous gout
                                            • Definitions

                                              • Hyperuricemia, resulting in sodium urate crystal deposition in soft tissues and joints
                                                • Primary gout: Results from abnormalities in purine metabolism or from idiopathic ↓ renal excretion of urate
                                                • Secondary gout: Results from increased serum uric acid levels resulting from associated disorder
                                                  • Neoplasms, lymphoproliferative disease
                                                  • Chronic renal failure
                                                  • Drug therapy (diuretics, ethanol, cytotoxics)
                                                • Saturnine gout: Results from chronic lead intoxication from either occult or occupational exposure or ingestion of moonshine

                                            IMAGING

                                            • General Features

                                              • Imaging Recommendations

                                                • Radiographic Findings

                                                  • Ultrasonographic Findings

                                                    • CT Findings

                                                      • MR Findings

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            • Microscopic Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Demographics

                                                                  • Natural History & Prognosis

                                                                    • Treatment

                                                                      DIAGNOSTIC CHECKLIST

                                                                      • Consider

                                                                        • Image Interpretation Pearls

                                                                          Selected References

                                                                          1. Girish G et al: Advanced imaging in gout. AJR Am J Roentgenol. 201(3):515-25, 2013
                                                                          2. Lumezanu E et al: Axial (spinal) gout. Curr Rheumatol Rep. 14(2):161-4, 2012
                                                                          3. Desai MA et al: Clinical utility of dual-energy CT for evaluation of tophaceous gout. Radiographics. 31(5):1365-75; discussion 1376-7, 2011
                                                                          4. Glazebrook KN et al: Identification of intraarticular and periarticular uric acid crystals with dual-energy CT: initial evaluation. Radiology. 261(2):516-24, 2011
                                                                          5. Konatalapalli RM et al: Gout in the axial skeleton. J Rheumatol. 36(3):609-13, 2009
                                                                          6. Cammalleri L et al: Rasburicase represents a new tool for hyperuricemia in tumor lysis syndrome and in gout. Int J Med Sci. 4(2):83-93, 2007
                                                                          7. Centers for Disease Control and Prevention (CDC): Projected state-specific increases in self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitations--United States, 2005-2030. MMWR Morb Mortal Wkly Rep. 56(17):423-5, 2007
                                                                          8. Choi HK et al: Prevalence of the metabolic syndrome in patients with gout: the Third National Health and Nutrition Examination Survey. Arthritis Rheum. 57(1):109-15, 2007
                                                                          9. Keith MP et al: Updates in the management of gout. Am J Med. 120(3):221-4, 2007
                                                                          10. Pascual E et al: Therapeutic advances in gout. Curr Opin Rheumatol. 19(2):122-7, 2007
                                                                          11. Perez-Ruiz F et al: Imaging modalities and monitoring measures of gout. Curr Opin Rheumatol. 19(2):128-33, 2007
                                                                          12. Reginato AM et al: Genetics and experimental models of crystal-induced arthritis. Lessons learned from mice and men: is it crystal clear? Curr Opin Rheumatol. 19(2):134-45, 2007
                                                                          13. Shah K et al: Does the presence of crystal arthritis rule out septic arthritis? J Emerg Med. 32(1):23-6, 2007
                                                                          14. Stamp LK et al: Emerging therapies in the long-term management of hyperuricaemia and gout. Intern Med J. 37(4):258-66, 2007
                                                                          15. Wise CM: Crystal-associated arthritis in the elderly. Rheum Dis Clin North Am. 33(1):33-55, 2007