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Gout - Making a diagnosis
Examination
- There is no single examination which confirms a diagnosis of gout. Look for evidence of:
- Arthritis (swelling, redness, warmth, pain on passive movement).
- The big toe (first metatarsophalangeal joint) is most frequently affected by gout.
- Other affected areas include the mid foot ('boot-lace' area of the foot), heel, ankle, knee, finger, wrist, and elbow (listed in order of decreasing frequency).
- Lower limb joints are affected more frequently than upper limb joints.
- Tophi (firm, white, translucent nodules).
- It usually takes at least 10 years after the first attack of acute gout for tophi to develop.
- Tophi are most commonly found on fingers, toes, ulnar side of forearms, olecranon bursae, prepatellar bursae, Achilles tendons, and the helix of the ears, but they can occur anywhere (e.g. in spinal canal, vocal cords), especially in older people.
- The pattern of tophi and joint involvement is characteristically asymmetric.
- In postmenopausal women who are taking diuretics, tophi can form over Heberden's nodes [O'Dell, 1983].
[Cohen and Emmerson, 1998; Nuki, 2002; Dutch College of General Practitioners, 2004; Schlesinger and Schumacher, 2004]
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