Gout M10.0

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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arthritis urica; goat(e); Gouty arthritis; Purine metabolic disorders

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Clinical manifestation of primary or secondary hyperuricemia in the form of acute and chronic arthritis and deposition of uric acid salts in the skin as such (see also uric acid, see also gout tophi).

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Primary gout: Autosomal dominant hereditary purine metabolic disorder. Secondary gout: Increased uric acid formation in hemolytic anemia, leukemia, cytostatic or radiotherapy of tumors. Decreased renal uric acid excretion in renal diseases, ketoacidosis, intake of saluretics.

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Primary gout: Occurs mainly in middle-aged and older men, in women practically never before menopause. Frequently associated with obesity, diabetes, lipid metabolism disorders.

Clinical features
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I. Acute attack of gout: Occurs frequently after an opulent meal or abundant alcohol consumption, but also completely spontaneously without any recognizable cause. Sudden onset of highly painful monarthritis (usually of the metatarsophalangeal joint of the big toe, so-called podagra), more rarely of the metacarpophalangeal joint or the metacarpophalangeal joint of the thumb (so-called chiragra) with strong, continuous, spontaneous or pressure-induced pain combined with redness and swelling. In particularly severe cases, fever, chills and general signs of inflammation.

II Chronic stage: Chronic, progressive, mutating arthritis of the peripheral joints. On the skin there is gout tophi. The occurrence of gouty arthritis is rarely observed (Gaviria JL et al. 2015).

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The following criteria (ARA criteria) are used to classify acute gouty arthritis (modified according to Wallace 1997):

A) Urate crystals in synovial fluid

B) Urate crystals in Tophus

C) Various

  1. Recurrent acute arthritis
  2. Ignition maximum within 24 hours
  3. Monarticular infestation
  4. redness of the metatarsophalangeal joint of the big toe
  5. pain, swelling of the metatarsophalangeal joint of the big toe
  6. Unilateral infestation of metatarsophalangeal joints of the toes
  7. Unilateral infestation of the tarsal
  8. Tophus
  9. Hyperuricemia - uric acid i.S. increased ( > 6.4 mg/dl)
  10. Asymmetrical swelling in the X-ray image
  11. Subcortical cyst without erosion
  12. Abacterial joint effusion

Arthritis can be classified as uric arthritis if at least one of criteria A, B, C is met, where C is considered to be met if 6 of the characteristics listed in 1-12 apply.

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Interstitial nephritis, nephrolithiasis.

General therapy
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Low purine diet, avoidance of alcohol as far as possible, normalization of body weight.

Internal therapy
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Acute attack of gout: Indometacin (e.g. Amuno) 3 times 50 mg/day or Acemetacin 120-180 mg/day (e.g. Rantudil forte 2-3 cps/day). Alternatively naproxen 500-1250 mg/day, divided into 2-3 ED p.o. or colchicine (Colchicum Dispert Drg.) 1 mg every hour for 4 hours, then 0.5-1 mg every 2 hours until the symptoms subside. Maximum daily dose 8 mg. Side effects: Diarrhea frequently (do not stop therapy, treatment with Imodium). Improvement of arthritis under colchicine usually prompt. Repeat the therapy the next day with half the dose. On day 3 1.5 mg colchicine per day. Treatment duration: 5 days. In case of renal insufficiency lower dosage.

Alternatively: Ibuprofen (2x 600mg), if necessary combined with prednisolone orally (50mg); reduce decreasing dosage to 0 within 1 week.

Chronic stage: Allopurinol (e.g. Zyloric) 300-600 mg/day, possibly uricosurics like Probenecid.

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Purine table: Foods that may be eaten with gout (values calculated as uric acid/100g)

  • milk 0 mg/100g
  • Yoghurt 0 mg/100g
  • Quark 0 mg/100g
  • Tea 0 mg/100g
  • coffee 0 mg/100g
  • egg 5 mg/100g
  • Cucumber 7 mg/100g
  • Tomatoes 10 mg/100g
  • Sweet peppers 10 mg/100g
  • Potatoes 15 mg/100g
  • Apples 15 mg/100g
  • Pear 15 mg/100g
  • Honeydew melon 18 mg/100g
  • Watermelon 20 mg/100g
  • Cheese 20 mg/100g
  • Courgettes 22 mg/100g
  • Wheat flour 38 mg/100g

Purine table: Foods that should be avoided with gout (values calculated as uric acid/100g)

  • Sprats 802 mg/100g
  • porcine spleen 600 mg/100g
  • Oil sardines 480 mg/100g
  • Trout 345 mg/100g
  • Calf's liver 288 mg/100g
  • Goose meat 254 mg/100g
  • Pork escalope 211 mg/100g
  • Tuna in oil 204 mg/100g
  • Peas 180 mg/100g
  • Brussels sprouts 170 mg/100g
  • Lentils 160 mg/100g
  • Fillet of beef 153 mg/100g
  • Beer, light with alcohol 15 mg/100g

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  1. Gaviria JL et al (2015) Unusual Dermatological Manifestations of Gout: Review of Literature and a Case Report. Plast Reconstr Surg Glob Open 3:e445

  2. Richette P et al.(2016) 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2016 Jul 25. doi: 10.1136/annrheumdis-2016-209707.
  3. Scherer M et al (2016) Association between multimorbidity patterns and chronic pain in elderly primary care patients: a cross-sectional observational study. BMC Fam Pract 17:68.
  4. Tzeng HE et al (2016) Gout increases risk of fracture: A nationwide population-based cohort study. Medicine (Baltimore) 95:e4669.
  5. Wallace SL et al (1977) Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum 20: 895-900.


Please ask your physician for a reliable diagnosis. This website is only meant as a reference.


Last updated on: 29.10.2020