-clinical syndrome caused by an inflammatory response to monosodium urate crystals formed, with hyperuricemia 

-under-excretion accounts for 90% of cases

-overproduction for 10%

-renal insufficiency

-DM, HTN

-drugs and toxins

-diuretics

-ethanol (lactic acidosis) or starvation (ketoacidosis)

-low dose aspirin 

-acidosis

-dehydration

-Ethanol

-enzyme deficiencies (HGPRT)

-synthetase overactivity (PRPP)

-myeloproliferative disorders such as leukemia, lymphoma

-chemotherapy

-hemolytic processes, psoriasis, Paget's

-Sickle cell

-glycogen storage disease

-principally a disease of men and lesser to post-menopausal women

-directly related to degree of hyperuricemia

-uric acid levels increase with age

-renal disease

-alcohol 

-abrupt onset of severe joint inflammation, often with onset at night

-first metatarsal (MTP) is most commonly affected

-PE: joint is warm, no ROM; skin is erythematous, violaceous

-can be one or more than one joint

-can progress to chronic gout 

-usually associated with tissue deposits of uric acid due to long standing hyperuricemia 

-tophi is produced, indicative of foreign body reaction to crystals

-will have inflammatory mediators 

-creates associated erosion of cartilage and bone 

-can be confused with RA nodules, but examination of fluid can diagnosis 

-athrocentesis to determine presence of crystals and rule out infection

-joint fluid is inflammatory with lots of WBC's (but less than in infectious)

-serum uric acid levels can help but may not be elevated in every case

-24 hour urine test

-X-ray

-NSAIDS

-Colchicine can be used initially to prevent further release of inflammatory cells

-corticosteroids, glucocorticoid injections

-colchicine prophylaxis 

-if patients have tophi, erosive joint disease, or renal stones, long term therapy is needed

-Colchicine and NSAIDS can be used for prophylaxis

-Allopurinol decreases uric acid levels in blood

-Probenecid increases secretion by acting on the tubules

-**if either last two are used, Colchicine or NSAIDS should be administered as well**