Gout - Revision history

Michael: /* www */ +SO

2017-11-30T20:22:51Z

www: +SO

← Older revision		Revision as of 20:22, 30 November 2017
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	*[http://www.archivesofpathology.org/na101/home/literatum/publisher/pinnacle/journals/content/arpa/2002/15432165-126.5/0003-9985%282002%29126%3C0621%3Apqcast%3E2.0.co%3B2/production/images/large/i1543-2165-126-5-621-f01.jpeg Gouty tophus - A. xray, B. Diff-Quick, C. Pap smear, D. polarized light, E. H&E (archivesofpathology.org)].		*[http://www.archivesofpathology.org/na101/home/literatum/publisher/pinnacle/journals/content/arpa/2002/15432165-126.5/0003-9985%282002%29126%3C0621%3Apqcast%3E2.0.co%3B2/production/images/large/i1543-2165-126-5-621-f01.jpeg Gouty tophus - A. xray, B. Diff-Quick, C. Pap smear, D. polarized light, E. H&E (archivesofpathology.org)].
	*[http://path.upmc.edu/cases/case205.html Gout - several images (upmc.edu)].		*[http://path.upmc.edu/cases/case205.html Gout - several images (upmc.edu)].

			==Sign out==
			<pre>
			Submitted as "Left Olecranon Bursa", Excision:
			- Consistent with gouty tophus; amorphous material with granulomatous reaction.
			</pre>

	==See also==		==See also==

Michael at 17:47, 30 December 2016

2016-12-30T17:47:03Z

← Older revision		Revision as of 17:47, 30 December 2016
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	\| Tx = medications (NSAIDs for pain, allopurinol, colchicine)		\| Tx = medications (NSAIDs for pain, allopurinol, colchicine)
	}}		}}
	'''Gout''' is a common benign affliction that can be disabling. It occasionally is seen by pathologists ~~and~~ can be grouped ~~with~~ conditions with [[crystals in body fluids]].		'''Gout''' is a common benign affliction that can be disabling. It occasionally is seen by pathologists. It can be grouped in conditions with [[crystals in body fluids]].

	==General==		==General==

Michael: /* Images */

2016-12-30T17:45:47Z

Images

← Older revision		Revision as of 17:45, 30 December 2016
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	Gout - monosodium urate crystals (20X, polarized, red compensator).jpg \| Urate crystals under [[polarized light]]. (WC/Gabriel Caponetti)		Gout - monosodium urate crystals (20X, polarized, red compensator).jpg \| Urate crystals under [[polarized light]]. (WC/Gabriel Caponetti)
	</gallery>		</gallery>
	www:		====www====
	*[http://www.archivesofpathology.org/na101/home/literatum/publisher/pinnacle/journals/content/arpa/2002/15432165-126.5/0003-9985%282002%29126%3C0621%3Apqcast%3E2.0.co%3B2/production/images/large/i1543-2165-126-5-621-f01.jpeg Gouty tophus - A. xray, B. Diff-Quick, C. Pap smear, D. polarized light, E. H&E (archivesofpathology.org)].		*[http://www.archivesofpathology.org/na101/home/literatum/publisher/pinnacle/journals/content/arpa/2002/15432165-126.5/0003-9985%282002%29126%3C0621%3Apqcast%3E2.0.co%3B2/production/images/large/i1543-2165-126-5-621-f01.jpeg Gouty tophus - A. xray, B. Diff-Quick, C. Pap smear, D. polarized light, E. H&E (archivesofpathology.org)].
	*[http://path.upmc.edu/cases/case205.html Gout - several images (upmc.edu)].		*[http://path.upmc.edu/cases/case205.html Gout - several images (upmc.edu)].

Michael: /* Images */

2016-12-30T17:45:26Z

Images

← Older revision		Revision as of 17:45, 30 December 2016
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	Image:Gouty_tophus_-_low_mag.jpg \| Gouty tophus - low mag. (WC)		Image:Gouty_tophus_-_low_mag.jpg \| Gouty tophus - low mag. (WC)
	Image:Gouty_tophus_-_high_mag.jpg \| Gouty tophus - high mag. (WC)		Image:Gouty_tophus_-_high_mag.jpg \| Gouty tophus - high mag. (WC)
			Gout - monosodium urate crystals (20X, polarized, red compensator).jpg \| Urate crystals under [[polarized light]]. (WC/Gabriel Caponetti)
	</gallery>		</gallery>
	www:		www:

Michael at 17:43, 30 December 2016

2016-12-30T17:43:56Z

← Older revision		Revision as of 17:43, 30 December 2016
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	\| Caption = Gouty tophus. [[H&E stain]].		\| Caption = Gouty tophus. [[H&E stain]].
	\| Synonyms =		\| Synonyms =
	\| Micro = urate crystals - see ''[[crystals in body fluids]]'' - ''not'' seen on formalin fixed sections; tophi (granulomatous inflammation - surrounds fluffy (cotton candy-like) material); fibrotic synovium		\| Micro = urate crystals - considered gold standard (see ''[[crystals in body fluids]]'') '''not''' seen on formalin fixed sections, tophi (granulomatous inflammation - surrounds fluffy (cotton candy-like) material), fibrotic synovium
	\| Subtypes =		\| Subtypes =
	\| LMDDx =		\| LMDDx =

Michael: more

2016-12-30T17:42:41Z

← Older revision		Revision as of 17:42, 30 December 2016
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	\| Caption = Gouty tophus. [[H&E stain]].		\| Caption = Gouty tophus. [[H&E stain]].
	\| Synonyms =		\| Synonyms =
	\| Micro =		\| Micro = urate crystals - see ''[[crystals in body fluids]]'' - ''not'' seen on formalin fixed sections; tophi (granulomatous inflammation - surrounds fluffy (cotton candy-like) material); fibrotic synovium
	\| Subtypes =		\| Subtypes =
	\| LMDDx =		\| LMDDx =
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	\| Grossing =		\| Grossing =
	\| Site = [[joints]] - classically large toe		\| Site = [[joints]] - classically large toe
	\| Assdx =		\| Assdx = +/-[[chronic renal failure]], +/-[[diabetes mellitus]]
	\| Syndromes =		\| Syndromes =
	\| Clinicalhx =		\| Clinicalhx = usually male
	\| Signs =		\| Signs =
	\| Symptoms = joint pain		\| Symptoms = joint pain
	\| Prevalence = common		\| Prevalence = common
	\| Bloodwork =		\| Bloodwork = urea elevated
	\| Rads =		\| Rads =
	\| Endoscopy =		\| Endoscopy =
	\| Prognosis = benign		\| Prognosis = benign
	\| Other =		\| Other =
	\| ClinDDx =		\| ClinDDx = other causes of joint pain - see ''[[arthritis]]''
	\| Tx =		\| Tx = medications (NSAIDs for pain, allopurinol, colchicine)
	}}		}}
	'''Gout''' is a common benign affliction that can be disabling. It occasionally is seen by pathologists and can be grouped with conditions with [[crystals in body fluids]].		'''Gout''' is a common benign affliction that can be disabling. It occasionally is seen by pathologists and can be grouped with conditions with [[crystals in body fluids]].

Michael: /* General */

2016-12-29T19:30:59Z

General

← Older revision		Revision as of 19:30, 29 December 2016
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	Epidemiology:<ref name=pmid22544037>{{Cite journal \| last1 = Wang \| first1 = Y. \| last2 = Yan \| first2 = S. \| last3 = Li \| first3 = C. \| last4 = Zhao \| first4 = S. \| last5 = Lv \| first5 = J. \| last6 = Wang \| first6 = F. \| last7 = Meng \| first7 = D. \| last8 = Han \| first8 = L. \| last9 = Wang \| first9 = Y. \| title = Risk factors for gout developed from hyperuricemia in China: a five-year prospective cohort study. \| journal = Rheumatol Int \| volume = 33 \| issue = 3 \| pages = 705-10 \| month = Mar \| year = 2013 \| doi = 10.1007/s00296-012-2439-8 \| PMID = 22544037 }}</ref>		Epidemiology:<ref name=pmid22544037>{{Cite journal \| last1 = Wang \| first1 = Y. \| last2 = Yan \| first2 = S. \| last3 = Li \| first3 = C. \| last4 = Zhao \| first4 = S. \| last5 = Lv \| first5 = J. \| last6 = Wang \| first6 = F. \| last7 = Meng \| first7 = D. \| last8 = Han \| first8 = L. \| last9 = Wang \| first9 = Y. \| title = Risk factors for gout developed from hyperuricemia in China: a five-year prospective cohort study. \| journal = Rheumatol Int \| volume = 33 \| issue = 3 \| pages = 705-10 \| month = Mar \| year = 2013 \| doi = 10.1007/s00296-012-2439-8 \| PMID = 22544037 }}</ref>
	*Male (Females RR ~ 0.1).		*Male (Females relative risk ~ 0.1).
	*Renal failure.		*Renal failure.
	*Diabetes mellitus.		*Diabetes mellitus.
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	**May be genetic, e.g. URAT1 mutation.<ref name=omim607096>{{OMIM\|607096}}</ref><ref>{{Cite journal \| last1 = Tin \| first1 = A. \| last2 = Woodward \| first2 = OM. \| last3 = Kao \| first3 = WH. \| last4 = Liu \| first4 = CT. \| last5 = Lu \| first5 = X. \| last6 = Nalls \| first6 = MA. \| last7 = Shriner \| first7 = D. \| last8 = Semmo \| first8 = M. \| last9 = Akylbekova \| first9 = EL. \| title = Genome-wide association study for serum urate concentrations and gout among African Americans identifies genomic risk loci and a novel URAT1 loss-of-function allele. \| journal = Hum Mol Genet \| volume = 20 \| issue = 20 \| pages = 4056-68 \| month = Oct \| year = 2011 \| doi = 10.1093/hmg/ddr307 \| PMID = 21768215 }}</ref>		**May be genetic, e.g. URAT1 mutation.<ref name=omim607096>{{OMIM\|607096}}</ref><ref>{{Cite journal \| last1 = Tin \| first1 = A. \| last2 = Woodward \| first2 = OM. \| last3 = Kao \| first3 = WH. \| last4 = Liu \| first4 = CT. \| last5 = Lu \| first5 = X. \| last6 = Nalls \| first6 = MA. \| last7 = Shriner \| first7 = D. \| last8 = Semmo \| first8 = M. \| last9 = Akylbekova \| first9 = EL. \| title = Genome-wide association study for serum urate concentrations and gout among African Americans identifies genomic risk loci and a novel URAT1 loss-of-function allele. \| journal = Hum Mol Genet \| volume = 20 \| issue = 20 \| pages = 4056-68 \| month = Oct \| year = 2011 \| doi = 10.1093/hmg/ddr307 \| PMID = 21768215 }}</ref>
	**Renal failure.		**Renal failure.

			Treatments:<ref name=pmid17910294>{{Cite journal \| last1 = Eggebeen \| first1 = AT. \| title = Gout: an update. \| journal = Am Fam Physician \| volume = 76 \| issue = 6 \| pages = 801-8 \| month = Sep \| year = 2007 \| doi = \| PMID = 17910294 }}</ref>
			*NSAIDs.
			*Allopurinol.
			*Colchicine - prophylatic.

	==Gross/radiology==		==Gross/radiology==

Michael: /* Microscopic */

2016-12-29T19:28:11Z

Microscopic

← Older revision		Revision as of 19:28, 29 December 2016
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	Note:		Note:
	*‡ The classically described [[polarization of light]] (see ''[[crystals in body fluids]]'') is ~~typically~~ ''not'' present in [[formalin]] fixed tissue.<ref name=pmid11504841>{{Cite journal \| last1 = Shidham \| first1 = V. \| last2 = Chivukula \| first2 = M. \| last3 = Basir \| first3 = Z. \| last4 = Shidham \| first4 = G. \| title = Evaluation of crystals in formalin-fixed, paraffin-embedded tissue sections for the differential diagnosis of pseudogout, gout, and tumoral calcinosis. \| journal = Mod Pathol \| volume = 14 \| issue = 8 \| pages = 806-10 \| month = Aug \| year = 2001 \| doi = 10.1038/modpathol.3880394 \| PMID = 11504841 }}</ref>		*‡ The crystals with the classically described [[polarization of light]] (see ''[[crystals in body fluids]]'') is ''not'' present in [[formalin]] fixed tissue.<ref name=pmid11504841>{{Cite journal \| last1 = Shidham \| first1 = V. \| last2 = Chivukula \| first2 = M. \| last3 = Basir \| first3 = Z. \| last4 = Shidham \| first4 = G. \| title = Evaluation of crystals in formalin-fixed, paraffin-embedded tissue sections for the differential diagnosis of pseudogout, gout, and tumoral calcinosis. \| journal = Mod Pathol \| volume = 14 \| issue = 8 \| pages = 806-10 \| month = Aug \| year = 2001 \| doi = 10.1038/modpathol.3880394 \| PMID = 11504841 }}</ref>

	===Images===		===Images===

Michael: /* Microscopic */

2016-12-29T19:27:25Z

Microscopic

← Older revision		Revision as of 19:27, 29 December 2016
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	***Surrounds fluffy (cotton candy-like) material.		***Surrounds fluffy (cotton candy-like) material.
	**Fibrotic synovium.		**Fibrotic synovium.
	**Aggregates of urate crystals. ~~(???)~~		*Aggregates of urate crystals - considered ''gold standard''.<ref name=pmid26175247>{{Cite journal \| last1 = Ting \| first1 = K. \| last2 = Graf \| first2 = SW. \| last3 = Whittle \| first3 = SL. \| title = Update on the diagnosis and management of gout. \| journal = Med J Aust \| volume = 203 \| issue = 2 \| pages = 86-8 \| month = Jul \| year = 2015 \| doi = \| PMID = 26175247 }}</ref> ‡

	Note:		Note:
	*The classically described [[polarization of light]] (see ''[[crystals in body fluids]]'') is typically ''not'' present in [[formalin]] fixed tissue.<ref name=pmid11504841>{{Cite journal \| last1 = Shidham \| first1 = V. \| last2 = Chivukula \| first2 = M. \| last3 = Basir \| first3 = Z. \| last4 = Shidham \| first4 = G. \| title = Evaluation of crystals in formalin-fixed, paraffin-embedded tissue sections for the differential diagnosis of pseudogout, gout, and tumoral calcinosis. \| journal = Mod Pathol \| volume = 14 \| issue = 8 \| pages = 806-10 \| month = Aug \| year = 2001 \| doi = 10.1038/modpathol.3880394 \| PMID = 11504841 }}</ref>		*‡ The classically described [[polarization of light]] (see ''[[crystals in body fluids]]'') is typically ''not'' present in [[formalin]] fixed tissue.<ref name=pmid11504841>{{Cite journal \| last1 = Shidham \| first1 = V. \| last2 = Chivukula \| first2 = M. \| last3 = Basir \| first3 = Z. \| last4 = Shidham \| first4 = G. \| title = Evaluation of crystals in formalin-fixed, paraffin-embedded tissue sections for the differential diagnosis of pseudogout, gout, and tumoral calcinosis. \| journal = Mod Pathol \| volume = 14 \| issue = 8 \| pages = 806-10 \| month = Aug \| year = 2001 \| doi = 10.1038/modpathol.3880394 \| PMID = 11504841 }}</ref>

	===Images===		===Images===

Michael: /* General */

2016-12-29T19:21:26Z

General

← Older revision		Revision as of 19:21, 29 December 2016
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	==General==		==General==
	*Classically afflicts the big toe - known as '''podagra'''.		*Classically afflicts the big toe - known as '''podagra'''.

			Epidemiology:<ref name=pmid22544037>{{Cite journal \| last1 = Wang \| first1 = Y. \| last2 = Yan \| first2 = S. \| last3 = Li \| first3 = C. \| last4 = Zhao \| first4 = S. \| last5 = Lv \| first5 = J. \| last6 = Wang \| first6 = F. \| last7 = Meng \| first7 = D. \| last8 = Han \| first8 = L. \| last9 = Wang \| first9 = Y. \| title = Risk factors for gout developed from hyperuricemia in China: a five-year prospective cohort study. \| journal = Rheumatol Int \| volume = 33 \| issue = 3 \| pages = 705-10 \| month = Mar \| year = 2013 \| doi = 10.1007/s00296-012-2439-8 \| PMID = 22544037 }}</ref>
			*Male (Females RR ~ 0.1).
			*Renal failure.
			*Diabetes mellitus.

	Etiology:<ref name=Ref_PCPBoD8>{{Ref PCPBoD8\|634}}</ref>		Etiology:<ref name=Ref_PCPBoD8>{{Ref PCPBoD8\|634}}</ref>