The Diagnosis of Gout

Abstract

Gout is the most commonly overlooked type of joint disease. The diagnosis usually is easy if the basic clinical picture is kept in mind; it is often made from the history alone. The typical subject is an obese, ruddy, otherwise healthy man, engaged in a sedentary occupation. The onset is very sudden, and the pain is very severe; usually only a single joint is involved at first. The pain often begins in the great toe joint or in the foot, and often begins at night. The affected joint is much swollen, very red and exquisitely tender. Early in the disease, attacks last from a few days to two weeks, with a gradual subsidence of symptoms. Following the acute attack the patient is absolutely free of all joint manifestations. The attacks almost always recur after some precipitating influence, such as an indiscretion in diet or the use of alcohol. With recurrences the same joint may be involved or the disease may appear in a single other joint or in several joints. In time the attacks are apt to last longer; finally, the disease may become chronic with marked joint deformity.

There are many variations of this fundamental typical picture. The disease may occur in women; the patient may not necessarily be healthy-looking; some other disease, such as leukemia or polycythemia, may precipitate an attack; the disease may run a chronic course from the onset; and any joint may be involved.

While there may be many different clinical pictures, gouty arthritis should. . .