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Tese embody: > acute illness > Trauma > Surgery > alcohol (especially beer and wines) > Diuretics, allopurinol 172 Internal Medicine Clinical treatment tips Chapiter 6: Musculoskeletal and Connective Tissues Conditions Intercritical gout пїЅ afer an preliminary acute attack sufferers may be free of symptoms for months or years; however some go on to have extra frequent assaults and a few ultimately develop chronic tophaceaous gout or permanent joint harm, or both, relying on diploma of hyperuricaemia Chronic tophaceous gout пїЅ Patients who develop chronic gout often are these whose hyperuricemia isn’t controlled пїЅ Crystal deposits (tophi) might develop round arms, ft, elbows, and ears as well as acutely afected joints Criteria for the scientific prognosis of gout (American College of rheumatology) Six or more of these standards are wanted to make a analysis пїЅ More than one assault of acute arthritis пїЅ Maximum infammation developed inside in the future пїЅ assault of monoarthritis пїЅ Redness over joints пїЅ Painful or swollen frst metatarsophalangeal joint пїЅ Unilateral assault on frst metatarsophalangeal joint пїЅ Unilateral assault on tarsal joint пїЅ Tophus (proved or suspected) пїЅ Hyperuricaemia пїЅ asymmetric swelling within a joint on radiograph пїЅ Subcortical cysts without erosions on radiograph пїЅ Joint fuid culture adverse for organisms throughout attack Complications Recurrent gout Tophi in advanced gout Kidney stones Joint injury Psychological efects Investigations 6 Serum urate focus: Hyperuricemia is defned as a serum or plasma urate focus greater than 7. 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