There are several features of gout and gouty arthritis of particular interest to the orthopaedic surgeon. A presumptive diagnosis of acute gout should be entertained in any unexplained acute inflammation of one or more joints, particularly in an adult male. A family history of gout, renal lithiasis, or other ancillary features, may be noted. Most important is a clinical description of the acute attack which displays the cardinal signs of inflammation and may be associated with pyrexia, leukocytosis, and an elevated sedimentation rate. Confirmation of the diagnosis rests upon a prompt response to a full course of colchicine. The level of serum uric acid is not a reliable diagnostic aid. Roentgenographic evidence in the earlier years of the disease is confined to soft-tissue swelling at the time of the acute attacks.
The pathogenesis of the acute attack is not known. The pathogenesis of the underlying metabolic disturbance is associated with an increased formation of uric acid by the body. Diminished destruction and impaired excretion by the kidneys as a cause have not been supported by contemporary research. Precipitating factors include surgical intervention, acute infection, emotional trauma, local trauma, and selected drugs administered parenterally.
The prognosis in gout is excellent if the prophylactic regimen is followed. This involves colchicine and a uricosunic agent (probenecid) administered daily in moderately or severely afflicted patients and less often in those mildly afflicted. If the prophylactic regimen is followed, little or no incapacity need result.
Copyright 1958 by The Journal of Bone and Joint Surgery, Incorporated