Difference between revisions of "Gout"

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#redirect [[Crystals_in_body_fluids#Gout]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Gouty_tophus_-_high_mag.jpg
| Width      =
| Caption    = Gouty tophus. [[H&E stain]].
| Synonyms  =
| Micro      = urate crystals - considered gold standard (see ''[[crystals in body fluids]]'') '''not''' seen on formalin fixed sections, tophi (granulomatous inflammation - surrounds fluffy (cotton candy-like) material), fibrotic synovium
| Subtypes  =
| LMDDx      =
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[joints]] - classically large toe
| Assdx      = +/-[[chronic renal failure]], +/-[[diabetes mellitus]]
| Syndromes  =
| Clinicalhx = usually male
| Signs      =
| Symptoms  = joint pain
| Prevalence = common
| Bloodwork  = urea elevated
| Rads      =
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    = other causes of joint pain - see ''[[arthritis]]''
| Tx        = medications (NSAIDs for pain, allopurinol, colchicine)
}}
'''Gout''' is a common benign affliction that can be disabling. It occasionally is seen by pathologists. It can be grouped in conditions with [[crystals in body fluids]].
 
==General==
*Classically afflicts the big toe - known as '''podagra'''.
 
Epidemiology:<ref name=pmid22544037>{{Cite journal  | last1 = Wang | first1 = Y. | last2 = Yan | first2 = S. | last3 = Li | first3 = C. | last4 = Zhao | first4 = S. | last5 = Lv | first5 = J. | last6 = Wang | first6 = F. | last7 = Meng | first7 = D. | last8 = Han | first8 = L. | last9 = Wang | first9 = Y. | title = Risk factors for gout developed from hyperuricemia in China: a five-year prospective cohort study. | journal = Rheumatol Int | volume = 33 | issue = 3 | pages = 705-10 | month = Mar | year = 2013 | doi = 10.1007/s00296-012-2439-8 | PMID = 22544037 }}</ref>
*Male (Females relative risk ~ 0.1).
*Renal failure.
*Diabetes mellitus.
 
Etiology:<ref name=Ref_PCPBoD8>{{Ref PCPBoD8|634}}</ref>
*Overproduction of uric acid ~ 10% of cases.
*Reduced excretion of uric acid ~ 90% of cases.
**May be genetic, e.g. URAT1 mutation.<ref name=omim607096>{{OMIM|607096}}</ref><ref>{{Cite journal  | last1 = Tin | first1 = A. | last2 = Woodward | first2 = OM. | last3 = Kao | first3 = WH. | last4 = Liu | first4 = CT. | last5 = Lu | first5 = X. | last6 = Nalls | first6 = MA. | last7 = Shriner | first7 = D. | last8 = Semmo | first8 = M. | last9 = Akylbekova | first9 = EL. | title = Genome-wide association study for serum urate concentrations and gout among African Americans identifies genomic risk loci and a novel URAT1 loss-of-function allele. | journal = Hum Mol Genet | volume = 20 | issue = 20 | pages = 4056-68 | month = Oct | year = 2011 | doi = 10.1093/hmg/ddr307 | PMID = 21768215 }}</ref>
**Renal failure.
 
Treatments:<ref name=pmid17910294>{{Cite journal  | last1 = Eggebeen | first1 = AT. | title = Gout: an update. | journal = Am Fam Physician | volume = 76 | issue = 6 | pages = 801-8 | month = Sep | year = 2007 | doi =  | PMID = 17910294 }}</ref>
*NSAIDs.
*Allopurinol.
*Colchicine - prophylatic.
 
==Gross/radiology==
*Radiologically may mimic ''anconeus epitrochlearis'' muscle.<ref>URL: [http://radiology.casereports.net/index.php/rcr/article/viewArticle/57/213 http://radiology.casereports.net/index.php/rcr/article/viewArticle/57/213]. Accessed on: 7 August 2011.</ref>
 
DDx:
*[[Epidermal inclusion cyst]]. (???)
 
==Microscopic==
Features:<ref>URL: [http://pathologyoutlines.com/joints.html#gout http://pathologyoutlines.com/joints.html#gout]. Accessed on: 5 August 2011.</ref>
*Tophi (advanced)
**Reactive granulomatous inflammation.
***Surrounds fluffy (cotton candy-like) material.
**Fibrotic synovium.
*Aggregates of urate crystals - considered ''gold standard''.<ref name=pmid26175247>{{Cite journal  | last1 = Ting | first1 = K. | last2 = Graf | first2 = SW. | last3 = Whittle | first3 = SL. | title = Update on the diagnosis and management of gout. | journal = Med J Aust | volume = 203 | issue = 2 | pages = 86-8 | month = Jul | year = 2015 | doi =  | PMID = 26175247 }}</ref> ‡
 
Note:
*‡ The crystals with the classically described [[polarization of light]] (see ''[[crystals in body fluids]]'') is ''not'' present in [[formalin]] fixed tissue.<ref name=pmid11504841>{{Cite journal  | last1 = Shidham | first1 = V. | last2 = Chivukula | first2 = M. | last3 = Basir | first3 = Z. | last4 = Shidham | first4 = G. | title = Evaluation of crystals in formalin-fixed, paraffin-embedded tissue sections for the differential diagnosis of pseudogout, gout, and tumoral calcinosis. | journal = Mod Pathol | volume = 14 | issue = 8 | pages = 806-10 | month = Aug | year = 2001 | doi = 10.1038/modpathol.3880394 | PMID = 11504841 }}</ref>
 
===Images===
<gallery>
Image:Gouty_tophus_-_low_mag.jpg | Gouty tophus - low mag. (WC)
Image:Gouty_tophus_-_high_mag.jpg | Gouty tophus - high mag. (WC)
Gout - monosodium urate crystals (20X, polarized, red compensator).jpg | Urate crystals under [[polarized light]]. (WC/Gabriel Caponetti)
</gallery>
====www====
*[http://www.archivesofpathology.org/na101/home/literatum/publisher/pinnacle/journals/content/arpa/2002/15432165-126.5/0003-9985%282002%29126%3C0621%3Apqcast%3E2.0.co%3B2/production/images/large/i1543-2165-126-5-621-f01.jpeg Gouty tophus - A. xray, B. Diff-Quick, C. Pap smear, D. polarized light, E. H&E (archivesofpathology.org)].
*[http://path.upmc.edu/cases/case205.html Gout - several images (upmc.edu)].
 
==Sign out==
<pre>
Submitted as "Left Olecranon Bursa", Excision:
    - Consistent with gouty tophus; amorphous material with granulomatous reaction.
</pre>
 
==See also==
*[[Crystals in body fluids]].
 
==References==
{{Reflist|2}}
 
[[Category:Diagnosis]]
[[Category:Crystals in body fluids]]

Latest revision as of 20:22, 30 November 2017

Gout
Diagnosis in short

Gouty tophus. H&E stain.
LM urate crystals - considered gold standard (see crystals in body fluids) not seen on formalin fixed sections, tophi (granulomatous inflammation - surrounds fluffy (cotton candy-like) material), fibrotic synovium
Site joints - classically large toe
Associated Dx +/-chronic renal failure, +/-diabetes mellitus
Clinical history usually male
Symptoms joint pain
Prevalence common
Blood work urea elevated
Prognosis benign
Clin. DDx other causes of joint pain - see arthritis
Treatment medications (NSAIDs for pain, allopurinol, colchicine)

Gout is a common benign affliction that can be disabling. It occasionally is seen by pathologists. It can be grouped in conditions with crystals in body fluids.

General

  • Classically afflicts the big toe - known as podagra.

Epidemiology:[1]

  • Male (Females relative risk ~ 0.1).
  • Renal failure.
  • Diabetes mellitus.

Etiology:[2]

  • Overproduction of uric acid ~ 10% of cases.
  • Reduced excretion of uric acid ~ 90% of cases.
    • May be genetic, e.g. URAT1 mutation.[3][4]
    • Renal failure.

Treatments:[5]

  • NSAIDs.
  • Allopurinol.
  • Colchicine - prophylatic.

Gross/radiology

  • Radiologically may mimic anconeus epitrochlearis muscle.[6]

DDx:

Microscopic

Features:[7]

  • Tophi (advanced)
    • Reactive granulomatous inflammation.
      • Surrounds fluffy (cotton candy-like) material.
    • Fibrotic synovium.
  • Aggregates of urate crystals - considered gold standard.[8] ‡

Note:

Images

  • Gouty tophus - low mag. (WC)

  • Gouty tophus - high mag. (WC)

  • Urate crystals under polarized light. (WC/Gabriel Caponetti)

www

Sign out

Submitted as "Left Olecranon Bursa", Excision: 
     - Consistent with gouty tophus; amorphous material with granulomatous reaction.

See also

References

  1. ↑ Wang, Y.; Yan, S.; Li, C.; Zhao, S.; Lv, J.; Wang, F.; Meng, D.; Han, L. et al. (Mar 2013). "Risk factors for gout developed from hyperuricemia in China: a five-year prospective cohort study.". Rheumatol Int 33 (3): 705-10. doi:10.1007/s00296-012-2439-8. PMID 22544037.
  2. ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 634. ISBN 978-1416054542.
  3. ↑ Online 'Mendelian Inheritance in Man' (OMIM) 607096
  4. ↑ Tin, A.; Woodward, OM.; Kao, WH.; Liu, CT.; Lu, X.; Nalls, MA.; Shriner, D.; Semmo, M. et al. (Oct 2011). "Genome-wide association study for serum urate concentrations and gout among African Americans identifies genomic risk loci and a novel URAT1 loss-of-function allele.". Hum Mol Genet 20 (20): 4056-68. doi:10.1093/hmg/ddr307. PMID 21768215.
  5. ↑ Eggebeen, AT. (Sep 2007). "Gout: an update.". Am Fam Physician 76 (6): 801-8. PMID 17910294.
  6. ↑ URL: http://radiology.casereports.net/index.php/rcr/article/viewArticle/57/213. Accessed on: 7 August 2011.
  7. ↑ URL: http://pathologyoutlines.com/joints.html#gout. Accessed on: 5 August 2011.
  8. ↑ Ting, K.; Graf, SW.; Whittle, SL. (Jul 2015). "Update on the diagnosis and management of gout.". Med J Aust 203 (2): 86-8. PMID 26175247.
  9. ↑ Shidham, V.; Chivukula, M.; Basir, Z.; Shidham, G. (Aug 2001). "Evaluation of crystals in formalin-fixed, paraffin-embedded tissue sections for the differential diagnosis of pseudogout, gout, and tumoral calcinosis.". Mod Pathol 14 (8): 806-10. doi:10.1038/modpathol.3880394. PMID 11504841.
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