What does gout look like

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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An acute attack of gout typically begins in the early morning hours.

Classically, it affects the big toe. Swelling, redness, heat, and agonizing pain are present. The pain is so severe that the victim cannot even bear the weight of a bedsheet on it.

The joint is dusky red in color and swollen.

This type of attack is called podagra. Podagra is generally due to gout but can also be seen in pseudogout although less commonly. Other diseases that must be differentiated from gout include cellulites, toe infection, rheumatoid arthritis, and Reiter’s syndrome.

Other joints may also be affected in gout. Gout can affect multiple joints over time. Attacks begin to become more frequent and joint destruction accompanied by kidney damage may occur. After a period of time, deposits under the skin, called tophi, may develop.

These lumps of tissue contain uric acid crystals and inflammatory cells. The lumps tend to occur near joints and at the elbows. Sometimes the tophi ulcerate and exude a chalky white pasty substance that is loaded with uric acid crystals.

In post-menopasual women, tophi can develop in the finger joints.

If a physician is able to aspirate fluid from the affected toe joint, there will be needle-shaped crystals of uric acid seen under a polarizing microscope. These crystals will reflect light in a certain way. They will exhibit what is known as negative birefringence.

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