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Y. El Miedany (ed.), Patient Reported Outcome Measures in Rheumatic Diseases,
DOI 10.1007/978-3-319-32851-5_9
Chapter 9
PROMs for Gouty Arthritis
Jasvinder Singh and Nipam Shah
Gout: The Disease and Its Manifestations
Gout is a debilitating, infl ammatory arthritis. Gout is characterized by hyperuricemia
and the related monosodium urate (MSU) crystal deposition within the joints and other
tissues. MSU crystal deposition is associated with infl ammatory arthritis, which leads
to severe joint and bursa pain, subcutaneous deposits of urate (tophi), formation of
urate calculi in kidneys and chronic systemic infl ammation [ 1 ]. Gout can be acute or
chronic in nature and is associated with substantial morbidity and impact on patient’s
health-related quality of life (HRQOL). The detection of needlelike MSU crystals in
the joint or synovial fl uid or aspirated material from a tophus showing strong negative
birefringence by polarized microscopy is the diagnostic of gout [ 2 ].
Acute gout—also referred to as gout attacks, gouty arthritis, or gout fl ares—can
involve synovial structures such as joints and tendons as well as bursa. Acute gout
is induced by infl ammatory cell reaction to joints/bursa associated with MSU crys-
tal deposition. The clinical manifestations include acute infl ammation joints/bursa
associated with moderate to severe pain and activity limitation. The acute attacks
involve peripheral joints and structures more commonly than the centrally located
structures. A majority of the acute gout attacks involve a single joint. The involve-
ment of metatarsophalangeal joint, especially the fi rst metatarsophalangeal (MTP),
also referred to as podagra, is a hallmark of gout.
Persistent clinical manifestations, also referred to as chronic gouty arthritis,
occur due to chronic infl ammation related to the continued deposition of MSU crys-
tals and are the natural evolution of untreated hyperuricemia in patients with gout.
Chronic gout is characterized by symmetric infl ammatory polyarthritis associated
J. Singh (*) • N. Shah
Department of Medicine , University of Alabama at Birmingham ,
510 20th Street South, FOT 805B , Birmingham , AL 35294 , USA
e-mail: [email protected]