Unusual Clinical Presentations of Gout

Tony C. Ning; Robert T. Keenan


Curr Opin Rheumatol. 2010;22(2):181 

In This Article


Gout has never been considered an infamous mimicker such as sarcoidosis or syphilis, but it has been shown to have the ability to mimic anything from infective endocarditis to spinal metastases. A thorough history, physical examination, clinical acumen, and an elevated index of suspicion are imperative in diagnosing the common and not-so-common presentations of gout. Dietary habits and comorbidities such as the metabolic syndrome (abdominal obesity, dyslipidemia, hypertension, insulin resistance) should be considered as associated risk factors with gout. In addition to a complete joint examination, a thorough physical examination of the skin, cartilaginous and soft tissues should be done in patients with risk factors for gout, family or personal history of gout. Measurement of serum urate should be included in the laboratory evaluation along with the comprehensive metabolic panel and complete blood count with differential. Clinicians should be aware of unusual presentations of gout in all patients with a variety of signs and symptoms. When confronted with a patient with a history of this disease and unusual findings, it may be wise to include a drop of bad humor in the differential, even in the absence of a color, dolor, rubor, et tumor of the great toe.


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