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== Clinical Summary ==
This patient was diagnosed with gout approximately 20 years ago. He has had numerous episodes of hot, painful, swollen joints involving the left knee, left ankle, and both first metatarsophalangeal joints. At the time of this admission the patient had increased serum uric acid values. In addition to his painful swollen joints, a gouty tophus was also present on the left arm. After remission of his acute gout flare-up the tophus was surgically removed.
The surgical specimen consisted of an elliptically shaped, mottled, yellow-white irregular hard mass, measuring 8.0 x 5.0 x 2.0 cm. in diameter.
== Images ==
<gallery heights="250px" widths="250px">
File:IPLab5Gout8.jpg|This is a gross photograph of a tophus on the great toe of another patient with gout (arrow). The healed surgical incision and the size of this tophus indicate that this was a long-standing problem for this patient.
</gallery>
== Virtual Microscopy ==
<peir-vm>IPLab5Gout</peir-vm>
== Study Questions ==
* <spoiler text="What are the two types of gout and which is more common?">The main type is primary gout which makes up 90% of all cases. In most cases of primary gout the specific enzyme defect is unknown but there is some enzyme abnormality which leads to hyperuricemia and symptoms of gout. In rare cases the specific enzyme defect is known, but gout symptomatology is the main clinical finding.
In secondary gout the cause of the hyperuricemia is known (e.g. leukemia, renal failure, Lesch-Nyhan syndrome).</spoiler>
* <spoiler text="What are the four stages of gout?"># Asymptomatic hyperuricemia
# Acute gouty arthritis
# Intercritical gout
# Chronic tophaceous gout.</spoiler>
* <spoiler text="Why is gout more severe in peripheral joints?">The decreased temperature accentuates the crystallization of monosodium urate (MSU).</spoiler>
* <spoiler text="What initiates the inflammatory reaction seen in the synovial membrane in gouty arthritis?">MSU crystals are chemotactic and they activate complement. This initiates a cascade of inflammatory events which leads to acute gouty arthritis.</spoiler>
== Additional Resources ==
=== Reference ===
* [http://emedicine.medscape.com/article/329958-overview eMedicine Medical Library: Gout and Pseudogout]
* [http://www.aafp.org/afp/1999/0215/p925.html American Academy of Family Physicians: Gout and Hyperuricemia]
=== Journal Articles ===
* Harris MD, Siegel LB, Alloway JA. [http://www.ncbi.nlm.nih.gov/pubmed/10068714 Gout and hyperuricemia]. ''Am Fam Physician'' 1999 Feb 15;59(4):925-34.
* Pittman JR, Bross MH. [http://www.ncbi.nlm.nih.gov/pubmed/10208700 Diagnosis and management of gout]. ''Am Fam Physician'' 1999 Apr 1;59(7):1799-806, 1810.
* Qaseem A, Harris RP, Forciea MA. [http://annals.org/aim/article/2578528/management-acute-recurrent-gout-clinical-practice-guideline-from-american-college Management of Acute and Recurrent Gout]. ''Ann Intern Med'' 2016 Nov 1 10;7326/M16-0570.
=== Images ===
* [{{SERVER}}/library/index.php?/tags/784-gout PEIR Digital Library: Gout Images]
== Related IPLab Cases ==
* [[IPLab:Lab 6:Rheumatoid Arthritis|Lab 6: Rheumatoid Arthritis]]
{{IPLab 5}}
[[Category: IPLab:Lab 5]]