Gout is a common and complex clinical syndrome defined by arthritis as an inflammatory response to monosodium urate (MSU) monohydrate crystal formation. These MSU crystals form and are deposited in joints and soft tissues as a result of hyperuricemia, the metabolic disorder that precedes gout. Gout most commonly manifests as a monoarticular arthropathy in the metatarsophalangeal joint of the big toe and affects other parts of the lower extremity, but upper extremity involvement of the wrist and/or fingers also occurs. Symptoms of gout flares in the hands are similar to typical arthritic symptoms and include pain, swelling, redness, and functional limitations. Most patients with gout can be effectively treated conservatively with anti-inflammatory medications and lifestyle modifications. More intense urate-lowering drug therapy may be needed for chronic gout. Surgery is reserved for rare cases that fail to improve with conservative treatment.1-3
Incidence and Related Conditions
Reproduced from the International statistical classification of diseases and related health problems, 10th revision, Fifth edition, 2016. Geneva, World Health Organization, 2016 https://apps.who.int/iris/handle/10665/246208
The typical patient is a 47-year-old obese man with hypertension and diabetes. He experienced his first flare of gout in his mid-30s, which was defined by pain, swelling, redness, and tenderness in his big toes and knees. Although he saw a doctor after having several more flares during that time, he did not make any significant modifications to his lifestyle, and the flares continued. More recently, the gout began to affect several DIP joints in his right hand, and symptoms prevented him from functioning normally, which led him to seek out medical advice.