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GOUT - Coggle Diagram

- - - - warm red swollen joint, lower limb joints affected more often than upper limb joints
      - Tophi - usually occurs over extensor joint aspect such as elbow, knee or achilles tendon, can occur in other areas such as helix of the ear or dorsum of hands and feet.
      - usually pain free but can becomes inflamed, infected or ulcerated of white discharge
      - tenderness and limited ROM
      - assess for septic arthritis, refer through local pathway if suspected
      - measure urate levels
    - - American college of Rheumatology criteria for diagnosing gout
        
        diagnosis of gout confirmed if: monosodium urate crystals are present in joint fluid or identified from tophus or six or more from the following apply:
        
        more than one attack of acute arthritis, inflammation developed within 1 day, redness observed over joints, joint painful and swollen, unilateral joint attack, unilateral tarsal joint attack, tophus, hyperuricaemia, asymmetrical swelling within joint from X-ray, subcortical cyst, joint culture VE- for organism during attack
- - - - Differential diagnosis
        
        Bursitis, tenosynovitis, cellulitis
        
        Haemochromatosis
        
        non urate crystal induced arthropathy such as pseudogout
        
        osteoarthritis, Psoriatic arthritis, reactive arthritis, Rheumatoid arthritis, septic arthritis
        
        Trauma
- - - - refer to local care pathways if septic arthritis is suspected
      - seek specialist advice when underlying systemic illness is suspected or if gout occurs during pregnancy or in a young person under 30 years of age.
      - the person is at risk of adverse effects of drug treatment
      - consider referring a person with gout to rheumatology service if: diagnosis of gout is uncertain, the response to treatment had not been adequate or not tolerated, treatment is contraindicated, they have CKD stage 3B-5. they have had organ transplant