Symptoms and clinical manifestations of gout

Gout is more common in middle-aged men, women accounted for only 5%, mainly women, gout after menopause at a younger age trend. The natural history of gout can be divided into four, namely asymptomatic hyperuricemia period of acute, intermittent, chronic phase. Clinical manifestations are as follows:

1. Acute gouty arthritis
No obvious signs before the onset of the majority of patients, or only fatigue, malaise and joint tingling. A typical attack often late at night and woke up because of joint pain, pain aggravated sexual, and peaked at 12 hours or so, was tearing, knife-like or biting kind, unbearable. Affected joints and surrounding tissue redness, swelling, heat, pain and functional limitation. More than a few days or two weeks to relieve itself. First attack multiple violations of a single joint, partially over the first metatarsophalangeal joint, in the course of the future, some of the patients involved in the site. Followed by the instep, heel, ankle, knee, wrist and elbow and other joints, shoulder, hip, spine and other joints and temporomandibular less involvement, which can involve multiple joints, manifested as polyarthritis. Some patients may have fever, chills, headache, nausea, palpitations and other symptoms may be associated with elevated white blood cell count, erythrocyte sedimentation rate and C-reactive protein increased faster and so on.

2. Intermittent attack
After the onset of gout for several days to several weeks to relieve itself, generally no significant residual symptoms, or left local skin pigmentation, scaling and itching and other symptoms after entering the interim period, which lasted several months, years, or ten years After relapse, most patients relapse within one year, the more the more frequent, more and more joint involvement, and longer duration of symptoms. Affected joints generally from the lower extremities to the upper limb, to the development of large joints from distal joints appear finger, wrist and elbow and other joints involved, few patients can affect the shoulder, hip, sacroiliac, sternoclavicular joint or spine, but also can affect the joints surrounding bursa, tendon and tendon sheath and other parts, the symptoms tend not typical. Small number of patients without intermission, after the initial onset of chronic arthritis was.



3. Chronic diseases of tophi
Subcutaneous tophi tophi and chronic arthritis is a long-term significant hyperuricemia, a lot of monosodium urate crystal deposition in the results of the skin, synovium, cartilage, bone and soft tissue around the joints. Typical parts subcutaneous auricular gout Shifa Sheng is also common in recurrent periarticular and olecranon bursa patella tendon and other parts. Look for the uplift of the sizes of yellow subcutaneous white growths, skin surface thin, white discharge after rupture powdery or paste, prolonged unhealed. Subcutaneous tophi tophi often coexist with chronic arthritis. Deposition of a large number of intra-articular tophi may cause joint bone destruction, periarticular fibrosis and secondary degenerative changes and so on. The clinical manifestations of persistent joint pain, tenderness, deformity and dysfunction. Chronic symptoms relative ease, but also may have acute episodes.

4. kidney disease
(1) chronic urate nephropathy urate crystal deposition in renal interstitial, resulting in a chronic renal tubular interstitial nephritis. Clinical manifestations of urine concentration function decline, increased nocturia appear, low specific gravity of urine, small molecules proteinuria, white blood cells in urine, mild hematuria and urinary tube and so on. Late can cause decreased glomerular filtration rate, renal insufficiency.
(2) urinary tract calculi uric acid concentration increased uric acid in urine was too saturated, deposition in the urinary system and the formation of stones. In gout patients, the incidence of 20% or more, and may appear before gouty arthritis. The smaller stones was gritty with the urine, may be asymptomatic; greater urinary tract obstruction can cause renal colic, hematuria, dysuria, urinary tract infection, renal pelvis dilation and water and so on.
(3) acute uric acid nephropathy uric acid levels in blood and urine abrupt increase, a large deposit of uric acid crystals in the renal tubules, collecting ducts, etc., resulting in acute urinary tract obstruction. Clinical manifestations of oliguria, anuria, acute renal failure; seen a lot of uric acid crystals in the urine. Caused more by cancer and chemotherapy (ie, tumor lysis syndrome) and other secondary causes.


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Article: Symptoms and clinical manifestations of gout

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