Symptoms Forest swooping ng

  Acute gout attacks

  Typical gout attacks

- The location and number of joint inflammation

Common in the joints of the lower extremities, 80% phosphate in a joint launch as joint goals Source Select incompetence, or knee, or other selected joints Source table, sometimes at the onset of tendon tendons that sticking point (Achilles), or even Press the soft tissues such as cellulitis (at the back of the foot, ankle, ankle).

- The circumstances appear

Gusts often appear spontaneous, sudden onset at night, after a meal or drink alcohol excessively; after injury; after surgical intervention; after a round of medications: aspirin, diuretics (thiazides, furosemmid), ethambutol, drugs, cell destruction ...

There may be a number of symptoms occurring before gout attacks such as headache, epigastric pain, urination, numbness toes. This is a good time for preventive treatment, not for the onset of an acute gout attack.

- Nature of joint inflammation:

Intense joint pain, burning, pain to the extreme after about 12 to 24 hours. Mainly nocturnal pain, loss of sleep. Often accompanied by fatigue, fever, sometimes 38-39 degrees C.

Check damaged joint swelling, heat, redness, pain. If the joints are most often associated hydrocephalus, small joints of the edema.

Respond to colchicine, the symptoms of complete remission after 48 hours cochicin up.

With an acute gout attack in the early stages often out quickly after a few days to 1-2 weeks, even without treatment removed.

 Gusts GYT atypical

- Subacute arthritis, swelling properties intense pain, knee effusion may simply.
- Inflammation of the joints many levels: signs suggest that the sudden onset, 3-4 joint inflammation, usually in the lower extremities. This can frequently in advanced stages of the disease and chronic gout stage.
- Items matching side effects acute tendinitis caused by gout, especially Achilles tendinitis, bursitis elbow.

 Chronic Gout

 Tophi

In the chronic stage of gout, after viom level, joints hurt not return to normal and can still swollen. Also often appear non-automotive particles.


Subcutaneous tophi began appearing around the joints and synovium, especially in the eyes of grass outside her pick, choose Source joints table, around the knee and elbow joints, along the veins in the hands and feet, around joints proximal and distal phalanges of the hand. The tophi usually make and mobile, leather covered above may be normal or thin and red. When the particle surface rupture, sediment looks like chalk and colored cream or pale yellow. Tophi may occur in areas not related to joints such as the ear, in organs such as the heart muscle, ventricular opening, aortic valve, spinal epidural.

Tuphi particle deposition shown piles chronic urate crystals in the organization, Goy Vice canceled tryc organization structure (joint). In the US, the medium grain tuphi the interior appearance since the first gout attack is 12 years, this time will depend on the state of hyperuricemia Still MOU and the risk factors such as diet does not control using steroids ... as long Koo promote tuphi particles appeared earlier, even after 2 years of starting septic patients [2].  
 rheumatoid disease caused by urate salts

- Monosodium urate salts accumulate Due to the tissue edge joints, cartilage and bone.
- Inflammation of the joints more often asymmetrical, joint swelling accompanied by deformation and joint destruction caused by tophi, accompanied by stiffness.
- X-ray damage to the room and piles cavity (the non-convergence reflux particles) are suggested: hook shape, narrow slot joints, secondary spines, sometimes lots of thorns.

- Ultrasound joints: Ultrasound can detect image urate crystals deposited on the articular cartilage in acute gout attacks the first or even the absence of clinical symptoms, as indicated by double-line image. Ultrasound can detect early changes in software, cartilage and bone caused by gout tophi as images with bone deposition of urate crystals on the surface of the articular cartilage, joint effusion. Many studies have described the ultrasound signal path having double the rate 31-92% and bone defects is 65-82%.

- Magnetic resonance imaging or computerized tomography allows detection of acne lesions of bone tissue, with bone calcification. Characteristic of tophi on magnetic resonance drive mixed-signal lesions, usually hypointense on both T1 and T2 sequences, increasing the drug absorbed from the optic cortex.

 The kidney damage in gout

  Gravel uric

- 10-20% of patients with kidney stones, gout and uric stones accounted for 5-10% of urinary tract stones
- Often expression by renal colic, or hematuria.
- Unenhanced stones usually only seen on contrast-enhanced imaging and renal ultrasound, often shot on both sides.
- There are three factors that increase uric promote Honh stones such as increased urinary excretion of uric acid, decreased urine volume and decreased urine pH

 Glomerular disease caused by urate (chronic urate nephropathy)

- The disease can be independent, not associated with kidney stones.
- Expression is viom glomerular and / or renal interstitial viom
- Symptoms: proteinuria infrequent and moderate; hematuria, urinary white blood corpuscle. Acidosis may increase blood chlor early manifestations; frequently associated with hypertension.
- Renal impairment: the former progressive renal failure are common in gout; 25% of gout patients have died due to kidney disease, but today this percentage has decreased a lot.

 Symptoms ready access concave

  Uric acid blood test

- Increased blood uric acid as: male above 70 mg / l (420 mmol / l), women over 60 mg / l (360 mmol / l).
- All patients with gout have hyperuricemia at some point in the process, proposing the disease, or increasing continuously. However, many people with hyperuricemia without express gout. In acute gout attack has to 12-43% of patients had blood levels of uric acid or the interior generally low [2].
- If normal blood uric acid does not exclude the diagnosis and vice versa if the high uric acid without clinical symptoms and no diagnosis of gout, to do for several consecutive days.

  The 24-hour urinary uric acid levels

- For the purpose of treatment guidelines: to determine the status increased excretion of urate (600 mg / 24 h) or relative emission reduction (less than 600 mg / 24 hours): If in the state increased urinary excretion of uric acid, not used group of uric acid lowering drugs have increased excretion mechanism (probenecid), or uric acid drugs tiou (uricozyme).  
Matching test (cytology sauce and shrimp shed urate crystals)

- Translation joint inflammation, rich cell (WBC 50,000 / 1 mm ^3), mostly polymorphonuclear leukocytes (not degraded)
- If you see urate crystals allows to confirm the diagnosis of gout attacks.

  The other common tests

- Increased erythrocyte sedimentation rate
- Leukemia increases, including polymorphonuclear leukocytes increased
- Testing blood sugar, liver function, kidney function, blood lipids. Gout is a metabolic disorder, so patients with gout are often accompanied by other metabolic disorders such as diabetes, dyslipidemia.  X-ray joints

- Phase gout, joint general image-rays normal
- Phase Chronic gout tophi: vulnerability is the drive piles with bone and socket (the non-convergence reflux particles) are suggested: hook shape, narrow slot joints, spines, sometimes lots of thorns, Goy spectrum destruction and deformation structure tryc joints.

  Supersonic

- Ultrasound renal parenchyma and radio surveys to assess renal pelvis nephritis, renal failure, urinary tract stones.
- Ultrasound joints: status survey joint synovitis, joint effusion, images double track joints of the toes in one foot, ankle, tophi, evaluate the destruction of bone and joint aspiration orientation fluid testing.