Difference between revisions of "Gout"

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Epidemiology:<ref name=pmid22544037>{{Cite journal  | last1 = Wang | first1 = Y. | last2 = Yan | first2 = S. | last3 = Li | first3 = C. | last4 = Zhao | first4 = S. | last5 = Lv | first5 = J. | last6 = Wang | first6 = F. | last7 = Meng | first7 = D. | last8 = Han | first8 = L. | last9 = Wang | first9 = Y. | title = Risk factors for gout developed from hyperuricemia in China: a five-year prospective cohort study. | journal = Rheumatol Int | volume = 33 | issue = 3 | pages = 705-10 | month = Mar | year = 2013 | doi = 10.1007/s00296-012-2439-8 | PMID = 22544037 }}</ref>
Epidemiology:<ref name=pmid22544037>{{Cite journal  | last1 = Wang | first1 = Y. | last2 = Yan | first2 = S. | last3 = Li | first3 = C. | last4 = Zhao | first4 = S. | last5 = Lv | first5 = J. | last6 = Wang | first6 = F. | last7 = Meng | first7 = D. | last8 = Han | first8 = L. | last9 = Wang | first9 = Y. | title = Risk factors for gout developed from hyperuricemia in China: a five-year prospective cohort study. | journal = Rheumatol Int | volume = 33 | issue = 3 | pages = 705-10 | month = Mar | year = 2013 | doi = 10.1007/s00296-012-2439-8 | PMID = 22544037 }}</ref>
*Male (Females RR ~ 0.1).
*Male (Females relative risk ~ 0.1).
*Renal failure.
*Renal failure.
*Diabetes mellitus.
*Diabetes mellitus.
Line 45: Line 45:
**May be genetic, e.g. URAT1 mutation.<ref name=omim607096>{{OMIM|607096}}</ref><ref>{{Cite journal  | last1 = Tin | first1 = A. | last2 = Woodward | first2 = OM. | last3 = Kao | first3 = WH. | last4 = Liu | first4 = CT. | last5 = Lu | first5 = X. | last6 = Nalls | first6 = MA. | last7 = Shriner | first7 = D. | last8 = Semmo | first8 = M. | last9 = Akylbekova | first9 = EL. | title = Genome-wide association study for serum urate concentrations and gout among African Americans identifies genomic risk loci and a novel URAT1 loss-of-function allele. | journal = Hum Mol Genet | volume = 20 | issue = 20 | pages = 4056-68 | month = Oct | year = 2011 | doi = 10.1093/hmg/ddr307 | PMID = 21768215 }}</ref>
**May be genetic, e.g. URAT1 mutation.<ref name=omim607096>{{OMIM|607096}}</ref><ref>{{Cite journal  | last1 = Tin | first1 = A. | last2 = Woodward | first2 = OM. | last3 = Kao | first3 = WH. | last4 = Liu | first4 = CT. | last5 = Lu | first5 = X. | last6 = Nalls | first6 = MA. | last7 = Shriner | first7 = D. | last8 = Semmo | first8 = M. | last9 = Akylbekova | first9 = EL. | title = Genome-wide association study for serum urate concentrations and gout among African Americans identifies genomic risk loci and a novel URAT1 loss-of-function allele. | journal = Hum Mol Genet | volume = 20 | issue = 20 | pages = 4056-68 | month = Oct | year = 2011 | doi = 10.1093/hmg/ddr307 | PMID = 21768215 }}</ref>
**Renal failure.
**Renal failure.
Treatments:<ref name=pmid17910294>{{Cite journal  | last1 = Eggebeen | first1 = AT. | title = Gout: an update. | journal = Am Fam Physician | volume = 76 | issue = 6 | pages = 801-8 | month = Sep | year = 2007 | doi =  | PMID = 17910294 }}</ref>
*NSAIDs.
*Allopurinol.
*Colchicine - prophylatic.


==Gross/radiology==
==Gross/radiology==

Revision as of 19:30, 29 December 2016

Gout
Diagnosis in short

Gouty tophus. H&E stain.
Site joints - classically large toe
Symptoms joint pain
Prevalence common
Prognosis benign

Gout is a common benign affliction that can be disabling. It occasionally is seen by pathologists and can be grouped with conditions with crystals in body fluids.

General

  • Classically afflicts the big toe - known as podagra.

Epidemiology:[1]

  • Male (Females relative risk ~ 0.1).
  • Renal failure.
  • Diabetes mellitus.

Etiology:[2]

  • Overproduction of uric acid ~ 10% of cases.
  • Reduced excretion of uric acid ~ 90% of cases.
    • May be genetic, e.g. URAT1 mutation.[3][4]
    • Renal failure.

Treatments:[5]

  • NSAIDs.
  • Allopurinol.
  • Colchicine - prophylatic.

Gross/radiology

  • Radiologically may mimic anconeus epitrochlearis muscle.[6]

DDx:

Microscopic

Features:[7]

  • Tophi (advanced)
    • Reactive granulomatous inflammation.
      • Surrounds fluffy (cotton candy-like) material.
    • Fibrotic synovium.
  • Aggregates of urate crystals - considered gold standard.[8] ‡

Note:

Images

  • Gouty tophus - low mag. (WC)

  • Gouty tophus - high mag. (WC)

www:

See also

References

  1. ↑ Wang, Y.; Yan, S.; Li, C.; Zhao, S.; Lv, J.; Wang, F.; Meng, D.; Han, L. et al. (Mar 2013). "Risk factors for gout developed from hyperuricemia in China: a five-year prospective cohort study.". Rheumatol Int 33 (3): 705-10. doi:10.1007/s00296-012-2439-8. PMID 22544037.
  2. ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 634. ISBN 978-1416054542.
  3. ↑ Online 'Mendelian Inheritance in Man' (OMIM) 607096
  4. ↑ Tin, A.; Woodward, OM.; Kao, WH.; Liu, CT.; Lu, X.; Nalls, MA.; Shriner, D.; Semmo, M. et al. (Oct 2011). "Genome-wide association study for serum urate concentrations and gout among African Americans identifies genomic risk loci and a novel URAT1 loss-of-function allele.". Hum Mol Genet 20 (20): 4056-68. doi:10.1093/hmg/ddr307. PMID 21768215.
  5. ↑ Eggebeen, AT. (Sep 2007). "Gout: an update.". Am Fam Physician 76 (6): 801-8. PMID 17910294.
  6. ↑ URL: http://radiology.casereports.net/index.php/rcr/article/viewArticle/57/213. Accessed on: 7 August 2011.
  7. ↑ URL: http://pathologyoutlines.com/joints.html#gout. Accessed on: 5 August 2011.
  8. ↑ Ting, K.; Graf, SW.; Whittle, SL. (Jul 2015). "Update on the diagnosis and management of gout.". Med J Aust 203 (2): 86-8. PMID 26175247.
  9. ↑ Shidham, V.; Chivukula, M.; Basir, Z.; Shidham, G. (Aug 2001). "Evaluation of crystals in formalin-fixed, paraffin-embedded tissue sections for the differential diagnosis of pseudogout, gout, and tumoral calcinosis.". Mod Pathol 14 (8): 806-10. doi:10.1038/modpathol.3880394. PMID 11504841.
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