Gout is an inflammatory reaction to urate crystals in joints, bones and subcutaneous structures. Initially, it is a hyperacute arthritis which may progress to a chronic arthritis. Rarely it may present as a chronic arthritis. Recognition of the crystals in fluid is pathognomonic. Gout occurs predominantly in men aged 30-60 years.
Primary gout, the most common form, is caused by an underexcretion or overproduction of uric acid. Secondary gout may be related to myeloproliferative diseases or their treatment, therapeutic regimens producing hyperuricemia, renal failure, renal tubular disorders, lead poisoning, hyperproliferative skin disorders, or enzymatic defects (e.g., deficient hypoxanthine guanine phosphoribosyltransferase, glycogen storage diseases).
Causes of gout include: Hyperuricemia; Dietary excess (e.g., anchovies, sardines, sweetbreads, kidney, liver and meat extracts); Inborn errors of metabolism; and Lead poisoning (Saturnine gout from moonshine).
Risk factors for gout include: Ethanol ingestion; Family history; Polynesian extraction (e.g., Samoan gout); Medications - aminophylline, caffeine, corticosteroids, cytotoxic drugs, diazepam, diphenhydramine, diuretics, L-dopa, dopamine, epinephrine, ethambutol, methaqualone, alpha-methyl dopa, nicotinic acid, probenecid (low dose), pyrazinamide, salicylates (< 10/dL blood levels), sulfinpyrazone (low dose), vitamins B12 and C.; Diuretics may be responsible for 20% of secondary gout; Ketosis; Surgery or trauma; Obesity (50%); Hypertension (50%); Vascular disease; Diabetes; Renal failure; Hypothyroidism; Hyperparathyroidism; hypoparathyroidism; Hyperlipidemia types II, IV, V; Paget's disease; Hyperproliferative skin disorders (e.g., psoriasis); Lymphoproliferative disorders; Calcium pyrophosphate deposition disease; Sarcoidosis; Hemolytic anemia; Hemoglobinopathies; Pernicious anemia; Radiation treatment; Type I glycogen storage disease; Down syndrome; and Gut sterilization by antibiotics.
Hyperuricemia may be present, although it is not diagnostic. WBC usually elevated with left shift during acute attacks. ESR usually elevated during acute attacks
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