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Rationale:
- Several arthritis syndromes may be associated with subcutaneous nodules, including rheumatoid arthritis, sarcoidosis, osteoarthritis
of fingers, and septic emboli with concomitant septic arthritis. None of these will have monosodium urate crystals present
in the synovial fluid.
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Evidence:
- Estimates of the frequency of several types of arthritis per 1000 persons derived from the 1989-1991 National Health Interview
Survey in conjunction with the 1990 U.S. Census (33) are as follows: gout, 8.4 (thought to be an overestimate by factor of 2); sarcoidosis, 1.1; spondyloarthropathy (Reiter's
plus psoriatic arthritis), 2.1; rheumatoid arthritis, 10.0; osteoarthritis, 121.
- The radiographic prevalence of pseudogout differs greatly with age, and pseudogout usually is not symptomatic. About one third
of individuals over 75 has chondrocalcinosis (34).
- Except for trauma, other disorders in the table Differential Diagnosis of Gout are less common.
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Comments:
- Inflammatory arthritis is generally most appropriately managed by a rheumatologist.
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Grace P. Teal, MD (deceased) has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Howard A. Fuchs, MD, is a consultant for TAP Pharmaceuticals.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott.
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The information included herein should never be used as a substitute
for clinical judgment and does not represent an official position of
ACP. Because all PIER modules are updated regularly, printed web pages
or PDFs may rapidly become obsolete. Therefore, PIER users should
compare the date of the last update on the website with any printout
to ensure that the information being referred to is the most current
available.
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PIER is copyrighted (c) 2009 by the American College of Physicians,
190 N. Independence Mall West, Philadelphia, PA 19106-1572, USA.
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Gout
> Diagnosis
