Gout

History

• h/o acute inflammatory arthritis? Which joints?
• Has it ever affected the 1^st MTP, midfoot, arch of foot, ankle, Achilles tendon?
• Other joints?
• Recent sepsis, UTI, PNA, SSTI, pyogenic process?
• When was the first attack?
• Did attack of arthritis begin during sleep?
• How long did initial attack last?
• How was it treated? Results?
• NSAIDS? Steroids?  Injections? Colchicine? Allopurinol? Probenecid? Other?
• How many attacks per year?
• How many in the past year?
• Has hyperuricemia been found?  What was it?
• Diuretics?  Cyclosporine?
• h/o renal failure or kidney stones?
• Previous aspiration? Fluid analysis?
• Xrays?
• Other diagnoses? Pseudogout? IBD? Psoriasis? Reiter’s?
• Family h/o gout?

Exam

• spine exam
• tophi exam: ears, olecranon bursa, fingers, toes, 1^st MTP, tendons (Achilles)
• skin: psoriasis affecting the scalp, elbows, knees, nails, other?
• Evidence of coincident diagnosis?