DIFFERENTIAL DIAGNOSIS for GOUT

By avn
11:54 am Posted November 18, 2016
In Gouty Arthritis

Gout attacks occur due to a combination of factors like food (consumption of food articles which are rich in protein), obesity, hypertension, insulin resistance and sometimes even genetic problems. Use of drugs (certain diuretics, niacin and low doses of aspirin) that increase the level of uric acid also leads to Gout. Gout is a form of inflammatory arthritis.

This figure represents the gout attack at the toe joint and swelling on the soft tissues.

The foremost criteria for diagnosis of gout is Septic Arthritis which does not improve with treatment. The next is the Synovial fluid (Fluid present within joints which helps lubrication of movement in joints) showing the presence of monosodium crystals. This test is difficult to perform as the pH and temperature factor has impact on its solubility. Other conditions that are similar to gout are Pseudogout and Rheumatoid Arthritis. Let us have a brief study of each one of these to see the similar conditions of Gout.

    • Septic Arthritis

It is an infection in the joint which is due to the migration of microorganisms through the bloodstream from one part of the body to the joints or due to an injury that carries micro-organisms directly into the joint. It’s a painful infection caused by bacteria or fungus. Most commonly it affects the Knee & hip joints.

Symptoms of Septic Arthritis are swelling in joints, fever and intense pain during movement of the joint.

Arthocentesis(aspiration of the synovial fluid through a needle and syringe) is the common procedure used to diagnose this Septic Arthritis. The fluid in the inflamed joint is taken for study under a microscope to detect the presence of micro-organisms. Presence of such microorganisms in the aspirated fluid confirms the diagnosis of septic arthritis. It can be differentiated from gout by the fact that it usually occurs after a systemic body infection or a direct injury to the affected joint and responds to the conventional treatment for septic arthritis.

    • Rheumatoid Arthritis

Rheumatoid Arthritis is an autoimmune disorder wherein the Immune system starts attacking one’s own joints in error. The white blood cells that create a chemical substance called cytokines tend to attack the linings of the joint called the synovial membrane. It results in the development of something called “Pannus Tissue” that develops and destroys the cartilage and the bone within the joint. This leads to inflammation and hence any movement of the joint becomes painful. Medication can improve the condition marginally but in most cases rheumatoid arthritis leads to physical disability if left untreated.

    • Pseudo-gout

Pseudo-gout is a condition that usually affects more than one joint particularly affecting the knee and wrist joints.It is caused due to the abnormal formation of Calcium Pyrophospate Crystals (CPP) in the cartilage which acts as a cushion for the material between bones. When this is released to the synovial fluid it causes an attack of arthritis known as Pseudo-gout which is similar to gout. The CPP crystals are formed due to heredity or during a joint injury or surgery.
People who have thyroid problems, kidney failure or disorders that affect calcium phosphate levels have a high risk of suffering from Pseudo-gout.

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