From the Guidelines
Classic physical exam findings of gout include acute monoarticular arthritis characterized by severe pain, erythema, warmth, and swelling of the affected joint, with the first metatarsophalangeal joint being the most commonly affected. The diagnosis of gout is supported by the presence of suggestive features such as monoarticular involvement of a foot or ankle joint, previous similar acute arthritis episodes, rapid onset of severe pain and swelling, erythema, and male gender, as well as associated cardiovascular diseases and hyperuricemia 1. Tophi, which are firm, white to yellow nodular deposits of monosodium urate crystals, can be found in chronic gout, typically in the ears, olecranon bursa, Achilles tendons, and finger pads, and may ulcerate and extrude a chalky, white material composed of urate crystals 1. Some key points to consider in the physical exam of a patient with suspected gout include:
- The presence of podagra, which is inflammation of the first metatarsophalangeal joint, occurring in about 50% of first gout attacks
- The presence of tophi, which are pathognomonic for gout and can be detected by physical exam or imaging approaches
- The presence of limited range of motion in the affected joint due to pain and swelling
- The presence of fever and malaise in some cases, due to the intense inflammation caused by the disease. It is essential to note that while these physical exam findings can support a diagnosis of gout, the reference standard for diagnosis is joint aspiration with synovial fluid analysis for monosodium urate crystals, and clinical algorithms that incorporate patient signs and symptoms, ultrasonography, and dual-energy computed tomography can also be useful in diagnosing gout 1.
From the Research
Classic Physical Exam Findings of Gout
- The provided studies do not directly discuss classic physical exam findings of gout, but rather focus on the treatment and management of acute gout [(2,3,4,5)].
- However, it can be inferred that a physical exam for gout would likely involve assessing joint pain, swelling, and inflammation, as these are common symptoms of the condition [(3,4,5)].
- The studies mention various treatments for acute gout, including NSAIDs, corticosteroids, colchicine, and interleukin-1 inhibitors, but do not provide specific information on physical exam findings [(2,3,4,5)].
Treatment-Related Findings
- The studies suggest that systemic corticosteroids, NSAIDs, and colchicine are effective treatments for acute gout [(2,3,5)].
- Adrenocorticotropic hormone (ACTH) is also mentioned as a potential treatment for acute gout [(3,4)].
- The efficacy and safety of these treatments are discussed in the studies, but physical exam findings are not explicitly mentioned [(2,3,4,5)].