Gout

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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.

Etiology:[1]

  • Overproduction of uric acid ~ 10% of cases.
  • Reduced excretion of uric acid ~ 90% of cases.
    • May be genetic, e.g. URAT1 mutation.[2][3]
    • Renal failure.

Gross/radiology

  • Radiologically may mimic anconeus epitrochlearis muscle.[4]

DDx:

Microscopic

Features:[5]

  • Tophi (advanced)
    • Reactive granulomatous inflammation.
      • Surrounds fluffy (cotton candy-like) material.
    • Fibrotic synovium.
    • Aggregates of urate crystals.

Images

www:

See also

References

  1. 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.
  2. Online 'Mendelian Inheritance in Man' (OMIM) 607096
  3. 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.
  4. URL: http://radiology.casereports.net/index.php/rcr/article/viewArticle/57/213. Accessed on: 7 August 2011.
  5. URL: http://pathologyoutlines.com/joints.html#gout. Accessed on: 5 August 2011.