Gout is characterized by episodes of acute attacks and it often presents in one joint, the first metatarsophalangeal joint (also known as MTP, the big toe).
Gout is more common in males than females.
Too much uric acid, hyperuricemia, leads to precipitation of monosodium urate crystals in joints, particularly in within peripheral joints where the temperature is relatively low. This is due to overproduction or underexcretion of uric acid.
This mechanism represents the majority of causes of primary gout. Examples include gouty disease due to thiazide diuretics, chronic kidney disease, where there is impaired excretion of uric acid.
This occurs in states of increased cell turnover such as cancer, psoriasis and chemotherapy-induced tumor lysis syndrome, where there is increased uric acid production.
Gouty crystals are found to be needle shaped and negatively birefringent when aspirated fluid from a joint is viewed under polarized light microscopy.
Acute gouty attacks are characterized by a swollen, red, painful joint.
Joints are affected asymmetrically, unlike in rheumatoid arthritis.
This refers to the classic manifestation of pain in the MTP (metatarso-phalangeal, big toe) joint.
Chronic tophaceous gout occurs in later stages of hyperuricemia. Tophi are large collections of urate crystals and the accompanying inflammation.
Lactate, a breakdown product of alcohol, competes with uric acid for the same excretion sites in the kidney. This can lead to decreased uric acid secretion.
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