Gout

• Facts:
  Acute monoarticular arthritis
  Intrarticular deposition of monosodium urate crystals secondary to urate metabolism disorders
  
• History / PE:
  MC affects MTP joint (podagra)
  Tophi (urate crystal deposits in soft tissue)
• Diagnosis:
  Needle-shaped, negatively birefringent crystals
  Punched-out erosions with overhanging cortical bone ("rat-bite" erosions) in advanced gout
  Synovial fluid analysis
• Treatment:
  ACUTE
  High dose NSAIDs (eg. indomethacin)
  Colchicine
  Steroids
  
  PREVENTION / MAINTENANCE
  Allopurinol (overproducers, eg. Lesch-Nyhan, hemolysis)
  Probenacid (undersecretors, MC)
  Stop ETOH
  Low purine diet
• Associated With:
  Myeloproliferative disorder (increased production of uric acid)
  Nephrolithiasis (uric acid stones)
• Differential Diagnosis:
  Pseudogout
  Septic arthritis