Difference between revisions of "Gout"

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| Caption    = Gouty tophus. [[H&E stain]].
| Caption    = Gouty tophus. [[H&E stain]].
| Synonyms  =
| Synonyms  =
| Micro      =
| 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  =
| Subtypes  =
| LMDDx      =
| LMDDx      =
Line 16: Line 16:
| Grossing  =
| Grossing  =
| Site      = [[joints]] - classically large toe
| Site      = [[joints]] - classically large toe
| Assdx      =
| Assdx      = +/-[[chronic renal failure]], +/-[[diabetes mellitus]]
| Syndromes  =
| Syndromes  =
| Clinicalhx =
| Clinicalhx = usually male
| Signs      =  
| Signs      =  
| Symptoms  = joint pain
| Symptoms  = joint pain
| Prevalence = common
| Prevalence = common
| Bloodwork  =
| Bloodwork  = urea elevated
| Rads      =
| Rads      =
| Endoscopy  =
| Endoscopy  =
| Prognosis  = benign
| Prognosis  = benign
| Other      =
| Other      =
| ClinDDx    =
| ClinDDx    = other causes of joint pain - see ''[[arthritis]]''
| Tx        =
| Tx        = medications (NSAIDs for pain, allopurinol, colchicine)
}}
}}
'''Gout''' is a common benign affliction that can be disabling. It occasionally is seen by pathologists and can be grouped with conditions with [[crystals in body fluids]].
'''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==
==General==
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Image:Gouty_tophus_-_low_mag.jpg | Gouty tophus - low mag. (WC)
Image:Gouty_tophus_-_low_mag.jpg | Gouty tophus - low mag. (WC)
Image:Gouty_tophus_-_high_mag.jpg | Gouty tophus - high 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>
</gallery>
www:
====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://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)].
*[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==
==See also==

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

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.