Focused Assessment in Suspected Acute Gout or Pseudogout
| Element | Comment |
|---|---|
| Time course and duration of joint and other symptoms | In gout, attacks begin abruptly, usually overnight, and typically reach maximum intensity within 12 hours. In pseudogout, attacks may resemble those of acute gout or follow a sub-acute course over several days. |
| Pattern of joint involvement | In gout, the first MTP joint (podagra) is the initial joint involved in 50% cases and is eventually involved in >90% of cases. Monoarticular involvement occurs commonly, although polyarticular acute flares do occur. In pseudogout, large joint involvement such as the knee, wrist, elbow or ankle. |
| Context and comorbidities | See Table 97.1. |
| History of trauma | Trauma may cause agitation, with subsequent deposition of urate and CPPD crystals in patients with tophi and chondrocalcinosis, respectively. |
| Examination of involved joint(s) | Swelling, warmth, redness (sometimes resembling cellulitis) and tenderness. |
| Other signs | In gout, tophi may be present in the helix of the ear, fingers, toes, prepatellar bursa, olecranon bursa. |
| Fever | May be present in polyarticular presentations of gout or pseudogout (septic arthritis must be excluded). |