Tophi vs podagra

Gout : Indomethacin Vs

Definition. Gout (also known as podagra when it involves the big toe) is a medical condition usually characterized by recurrent attacks of acute inflammatory arthritis—a red, tender, hot, swollen joint. The metatarsal-phalangeal joint at the base of the big toe is the most commonly affected, in around half of all cases. However, it may also present as tophi, kidney stones, or urate nephropathy Frequently, uric acid tophi (hard, uric acid deposits under the skin) are present and contribute to bone and cartilage destruction. Tophi are diagnostic for chronic tophaceous gout. Tophi can be found around joints, in the olecranon bursa, or at the pinna of the ear. With treatment, tophi can be dissolved and will completely disappear over time

A tophus (plural: tophi) happens when crystals of the compound known as sodium urate monohydrate, or uric acid, builds up around your joints. Tophi often look like swollen, bulbous growths on your. podagra (arthritis attacks of great toe) crystal deposition as tophi. ear helix, eyelid olecranon, Achilles tendon. Risk factors. chemotherapy. Etiology. Forms. primary gout. an idiopathic disorder of nucleic acid metabolism that leads to hyperuricemia and deposition of monosodium urate crystals in joints (a purine breakdown product

Gout Symptoms and Diagnosis Johns Hopkins Arthritis Cente

Tophi often present in patients with gouty arthritis for more than 10 years. The first metatarsophalangeal joint (joint at the base of the big toe also known as podagra) is the most frequent site of gouty tophi 3) Early: edematous synovium with acute and chronic inflammatory infiltrate Late: tophi (large aggregates of urate crystals, granulomatous inflammation, hyperplastic fibrotic synovium); gout crystals are long, slender, needle shaped but difficult to visualize with routine staining because they are dissolved during formalin processing (crystals are water soluble); easier to identify on scrape or. Colchicine. Colchicine prevents gout flares at a dosage of 0.6 to 1.2 mg per day. The dose should be adjusted in patients with chronic kidney disease and when used with cytochrome P450 3A4 or P.

Tophus in Gout: Tophi Removal, Treatment, and Mor

Gout - Basic Science - Orthobullet

Gout (podagra or uric acid arthropathy) Get expert advice on the causes, symptoms and treatment of gout. prevent and treat tophi and to stop the production of stones in the urinary system This test uses sound waves to detect urate crystals in joints or in tophi. Dual-energy computerized tomography (DECT). This test combines X-ray images taken from many different angles to visualize urate crystals in joints. Treatment. Gout medications are available in two types and focus on two different problems. The first type helps reduce the. INTRODUCTION — A gout flare is an intensely painful and disabling inflammatory arthritis, usually involving a single joint but occasionally involving two or more joints. The goal of therapy in a gout flare is prompt and safe termination of pain and disability. Without therapy, the gout flare usually resolves completely within a few days to several weeks, particularly in early disease

Tophi may cause erosion of the bone and eventually joint damage and deformity (called gouty arthropathy). Developing tophi near the small joints of the feet or fingers can cause physical changes that can not only be distressing (due to the cosmetic appearance) but also contribute to restricted movement and disability. Tophi are usually not. benign. Clin. DDx. other causes of joint pain - see arthritis. Treatment. medications (NSAIDs for pain, allopurinol, colchicine) 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

Gout vs. Psoriatic Arthritis: Differences in Symptoms and ..

Diagnosis and Management of Gout - American Family Physicia

  1. Tophi may develop earlier in older women, particularly those receiving diuretics. [80, 81, 82] Acute podagra due to gout in elderly man. Gout. Tophaceous deposits in ear..
  2. The Gout Forum › Gout pain, knee (Gonagra) vs foot (Podagra) Tagged: Forum for Gout Victims , Gout in Knee Forum , Gout Symptoms Forum This topic has 2 replies, 3 voices, and was last updated 11 months, 3 weeks ago by Keith Taylor
  3. Tophi are soft tissue masses created by the deposition of urate crystals. Urate is not inherently radio-opaque. The varying densities seen on radiographs is due to calcium precipitation with the urate crystals. Tophi are typically located in the peri-articular area along the extensor surface, but maybe intra-articular or not associated with the.
  4. Assisted Living vs. Senior Home Care known as podagra, and it acid levels in the body are chronically high it can lead to the development of hard deposits beneath the skin called tophi and.
  5. 2. Infected joint (septic arthritis) A single joint that's red, hot, and swollen might be gout — or it might be septic arthritis. To further add to the confusion, both conditions can cause you to develop a fever and for your white blood cell count to spike. In either instance, your body thinks you have an infection it's trying to fight.
  6. Gout is a type of arthritis that causes sudden and severe attacks of pain, but luckily, the right diet can ease its symptoms. This article reviews the best diet for gout, all backed by research
03 Joint Dz at Ross University School of Medicine - StudyBlueGout (Gounty Arthritis, Crystal Arthritis) | MED Expert

Gout is something that plagues more and more people every day, and it's caused from uric acid buildup in the body. I want to go over my top six home gout remedies — all-natural ways to beat gout symptoms — but right before that, go over the diet that is crucial to get rid of gout, along with the worst food offenders.. So if you have gout, the first thing you have to do is eliminate the. gout. . Acute gout. flares typically manifest with a severely painful big toe (. podagra. ) and occur most often in men following triggers such as alcohol consumption. Diagnosis is based on clinical presentation and, ideally, by the demonstration of negatively. birefringent. monosodium urate (MSU) crystals Chronic gout sufferers may feel tiny, hard lumps accumulating over time in the soft flesh of areas such as the hands, elbows, feet, or earlobes. These deposits, called tophi, are concentrations of. Tophi develop • Acute flares continue. Advanced gout • Chronic arthritis • Polyarticular acute flares with upper extremities more involved • Avg. time from initial attack to chronic gout is 11.6 yrs. Tophi. Solid urate deposits In tissues. Tophi. Irregular & destructive. Tophi risk factors • Long duration of hyperuricemia • Higher. podagra, was first identified by Egyptians in 2640 B.C. and con-tinues to be a medical health problem today [1]. The hallmark of gout is hyperuricemia with subsequent deposition of monosodium urate (MSU) crystals, which leads to inflam-mation and symptoms. Improved under-standing of the pathophysiology of gout an

Tophi Is Lumps Of Urate Growing Beneath The Skin

Allopurinol is used in the treatment of high uric acid levels associated with gout, kidney stones, and cancer treatment, it should not be used for asymptomatic high uric acid levels. If a rash occurs while taking allopurinol, immediate discontinuation of allopurinol is required and urgent medical advice should be sought. 5 Gouty tophi are nodular masses of monosodium urate crystals deposited in the soft tissues of the body. They are a late complication of hyperuricaemia and develop in more than half of patients with untreated gout. Complications of tophi include pain, soft tissue damage and deformity, joint destruction and nerve compression syndromes such as carpal tunnel syndrome Research could prefer to take it daily intakes like Omega 3 and 6 - how to treat podagra pain relief these oils may well have found out about your podagra and often cured for long-term is very important information about gout symptoms and Warning Signs of Gout consist of a gouty arthritis by slowly flexing and rotating the inflammation may. Edward Roddy, Revisiting the pathogenesis of podagra: why does gout target the foot?, Journal of Foot and Ankle Research, 10.1186/1757-1146-4-13, 4, 1, (2011). Crossref G. Meyer zu Reckendorf and D. Lupascu , L'atteinte des tendons fléchisseurs dans la maladie goutteuse. À propos d'un cas et revue de la littérature , Chirurgie de la Main. Gout is characterised by acute onset of severe joint pain, with swelling, effusion, warmth, erythema, and or tenderness of the involved joint(s). Arthrocentesis with synovial fluid analysis shows strongly negative birefringent needle-shaped crystals under polarised light. Non-steroidal anti-infla..

Gout Radiology Reference Article Radiopaedia

  1. Untreated gout may cause deposits of urate crystals to form under the skin in nodules called tophi (TOE-fie). Tophi can develop in several areas, such as your fingers, hands, feet, elbows or Achilles tendons along the backs of your ankles. Tophi usually aren't painful, but they can become swollen and tender during gout attacks. Kidney stones
  2. Podagra (initial joint manifestation in 50% of gout cases and eventually involved in 90%; also observed in patients with pseudogout and other conditions) Arthritis in other sites - In gout, the instep, ankle, wrist, finger joints, and knee; in pseudogout, large joints (eg, the knee, wrist, elbow, or ankle
  3. Men seemed to have a higher prevalence of podagra at their first attack, 52% of the women vs 57% of the men . Puig et al. found significantly more tophi in female gout patients compared to male, 27% in women vs 10% in men . Lally et al. found a higher prevalence of polyarticular gout in male patients, 56% of the women vs 80% of the men

15 Most Common Signs of Gout Once upon a time, gout or gouty arthritis was known as the disease of kings. It was considered to be more prevalent among overweight, wealthy men who could afford to over-indulge in alcohol and fatty foods. While obesity and diet remain important risk factors for gout, your bank account [ Manifestations of Gout. There are three manifestations of gout used to classify the severity of gout. Gout flares - Uric acid crystals that have formed over years or decades of hyperuricemia will at some time lead to a sudden onset of severe pain, swelling and tenderness. This usually occurs in one or two joints in the feet or legs The 5-year risk for developing gout is approximately 0.6% if the level is below 7.9 mg/dL, 1% if it is 8-8.9 mg/dL, and 22% if it is higher than 9 mg/dL. Previous. Next: Synovial Fluid Analysis. Urinary Uric Acid. A 24-hour urinary uric acid evaluation is generally performed if uricosuric therapy is being considered

Clinical Features. Acute gout affecting the first MP joint (podagra) Tophaceous gout affecting the right great toe and finger interphalangeal joints. Note the asymmetrical swelling and yellow-white discoloration. Distribution of joints typically affected by gout. Joint pain may develop over period of hours. Primarily involves first MTP, knee. Tophi have intermediate or low signal intensity on T1-weighted images and heterogeneous signal intensity on T2-weighted or fluid-sensitive sequences, possibly because of the presence of variable amounts of calcium [4, 64]. Tophi can show uniform enhancement or show a nonenhancing center [4, 65]. Bone erosions adjacent to tophi can produce. Tophi of the helix or antihelix of the ear are classic but less common. Tophi have also been reported in the eye, 20 carpal tunnel, 21 and heart valves. 22 In these situations, diagnosis is often. Tophi are deposits of uric acid crystals in one or more joints, or in subcutaneous and other tissues [1,2]. They commonly deposit in the feet (the first metatarsophalangeal joint lead- ing to podagra), ankles, knees, hands, wrists and elbows Gout. Gout is a heterogeneous metabolic disease associated with elevated serum uric acid levels (> 6.8 mg/dL) and abnormal deposits of monosodium urate in tissues. The condition is often familial and is initially characterized by painful, recurring, and usually monoarticular acute arthritis, or gout flare, followed later by chronic.

Difference Between Gout and Bunion Gout and bunion are two extremely different medical conditions that have a set of similar symptoms that might be misleading. Definition Gout is a medical condition characterized by excess of uric acid levels in the blood leading to deposition of crystals of uric acid in the joints. It starts with depositions in the great toe [ Rheumatoid arthritis (RA) is a chronic multisystem disease with predominant musculoskeletal manifestations.Being a disease that primarily attacks synovial tissues, RA affects synovial joints, tendons, and bursae. Refer to the related articles for a general discussion of rheumatoid arthritis and for the particular discussion of its respiratory and/or cardiac manifestations Gout is a type of arthritis that causes inflammation, usually in one joint, that begins suddenly.; Gouty arthritis is caused by the deposition of needle-like crystals of uric acid in a joint.; Gout symptoms and signs include. nodules under the skin called tophi, joint redness,; swollen joints,; joint pain, and; warmth of the joint. The most reliable method to diagnose gout is to have fluid. Background To characterize the differences between women and men with gout. Methods We analyzed a US national cohort of gout patients cared for by rheumatologists. Results Compared with the 1012 men with gout, women with gout (n = 262) were older (71 vs. 61 years, p < 0.001) and had a greater burden of comorbid conditions (p < 0.001 for hypertension, diabetes, renal disease and obesity). Risk. The presence of gout can also present in an affected joint (i.e., big toe, fingers, elbows, heels, ankles, and knees) - its presence being marked with swelling, redness, and a shiny or glossy surface. The affected skin may also be extremely itchy and warm, and peeling of the skin may occur as the pain and swelling diminishes

sudden severe pain in a joint - usually your big toe, but it can be in other joints in your feet, hands, wrists, elbows or knees. hot, swollen, red skin over the affected joint. These are symptoms of gout. An attack of gout usually lasts 5 to 7 days, then gets better. It may not cause lasting damage to joints if you get treatment immediately Gout is a type of arthritis. It occurs when uric acid builds up in blood and causes inflammation in the joints. Acute gout is a painful condition that often affects only one joint. Chronic gout is the repeated episodes of pain and inflammation. More than one joint may be affected Here are 20 of the most common symptoms of gout. 1. Pain In The Toe. Pain in the big toe is one of the most notable symptoms of gout, and the sign that often plagues sufferers the most. This symptom, referred to by medical doctors as podagra, is often what brings about a gout diagnosis

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In patients with known tophaceous gout, dual-energy CT may be used for serial volumetric quantification of subclinical tophi to evaluate response to treatment. Given the utility of dual-energy CT in challenging cases and its ability to provide an objective outcomes measure in patients with tophaceous gout, dual-energy CT promises to be a unique. Clinical Aspects of Gout ICD-9 -CM Coordination and Maintenance Committee Meeting September 24 -25, 2008 Joseph D. Croft, Jr, MD, FACP, MACR Clinical Professor of Medicine (Rheumatology) Georgetown University Medical Schoo

ACUTE GOUT First attack 4th-6th decade for men Women almost always postmenopausal Classically monoarticular LE- podagra (50%), (vs pseudopodogra) >ankle >gonagra >upper extremity. Proximal joint, central arthropathy uncommon 16. MSU CPPD Hydroxyapatite Septic Psoriatic, Reiter's Rheumatoid 17 Acute gouty arthritis can affect ≥1 joint; the 1st metatarsophalangeal joint is most commonly involved at presentation (podagra). Gout is related to a hyperuricemia (serum uric acid level >6.8 mg/dL) ( 1 )[ C ] and although hyperuricemia is necessary for the development of gout, it is not the only determining factor Gout, unspecified. M10.9 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2021 edition of ICD-10-CM M10.9 became effective on October 1, 2020. This is the American ICD-10-CM version of M10.9 - other international versions of ICD-10 M10.9 may differ Gout is an asymmetrical polyarticular disease, most often affecting the foot (9a). There is a predilection for the first metatarsophalangeal (MTP) joint, a condition known as podagra. Erosions are typically frequent along the medial and dorsal aspect of the joint (10a), and hallux valgus deformity is often seen, though any joint can be affected

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This, in turn, leads to swelling and redness around the affected joint, and, ultimately, severe pain. Podagra accounts for more than half of the reported cases of gout. 3. Symptoms can appear suddenly, especially at night, and can gradually worsen over a period of a few hours. Pain will usually last for anywhere from 5-10 days, and. Gout (Podagra) Gout is a painful arthritic condition that can affect any joint, but commonly involves the first MTP joint. Gout occurs when uric acid (urate) crystallizes in the synovial lining of the involved joint. Once in the joint, these crystals induce synovial macrophages to produce inflammatory cytokines such as Interleukin-1 (IL-1) In a study from Taiwan, of 1079 Chinese patients with gout, 25% had disease onset below the age of 30 years 5 . The present study revealed that almost 18% of patients with gout belong to YOG group. This subset is characterized by acute intermittent polyarthritis, paucity of podagra and early tophi formation


Figure. Known as the disease of kings, gout has been affecting man since 2460 BC. In ancient Egypt, the prevalence of gout was related to wealthy men overindulging with food and drink. 1,2 It is estimated that approximately 6 to 8 million people are affected by gout in the United States. 3 Gout is rarely found in children. Men are affected more than women; however, the disparity seems to. The attached image is of the patient with multiple large tophi due to Gouty arthritis. Gout is a common and painful form of inflammatory arthritis that occurs due to excessive uric acid in the body, called hyperuricemia. Uric acid is formed in the body by the breakdown of purines which occur naturally in the body and also contained in certain.

Although the classic location of gouty tophi is the great toe (podagra), gouty tophi of the ear also is common and is worth including in the differential diagnosis in patients presenting with ear lesions. Other entities presenting as papules or nodules on the ear include chondrodermatitis nodularis helicis (CNH), actinic keratosis, basal cell carcinoma, squamous ity, and tophi. Nearly 10% of those aged > 65 years report having gout. The overall prevalence in the U.S. population approaches 4%.1 Gout treatment has 2 overarch-ing goals: alleviating the pain and inflammation caused by acute gout attacks and long-term management that is focused on lowering serum urate (sUA) levels to reduce the ris Tophi võib moodustuda naha alla. Need on moodustuvad uraatide ladestused. Ärahoidmine: Inimesed võivad proovida vähendada podagra tekke riski, järgides tervislikke eluviise ja söömata liiga palju toite, näiteks teatud tüüpi liha, milles on palju puriine. Samuti saavad nad veenduda, et nad ei muutu liiga ülekaaluliseks, kuna rasvumine. Avoid meats such as liver, kidney and sweetbreads, which have high purine levels and contribute to high blood levels of uric acid. Red meat. Limit serving sizes of beef, lamb and pork. Seafood. Some types of seafood — such as anchovies, shellfish, sardines and tuna — are higher in purines than are other types Case. A 45-year-old obese, Caucasian male presented to urgent care with a chief complaint of right thumb swelling, redness, and excruciating pain for five days (Figure 1). Figure 1. Swollen, red, painful right thumb, tender to palpation with mild purulent discharge in the interphalangeal area. Redness also extended to the base of the right thumb

The word gout comes from the Greek word podagra, which literally translates to foot grabber. Gout is a type of arthritis caused by a buildup of uric acid and characterized by foot pain, swelling, redness, and difficulty walking is typically localized in the big toe Gout results from deposits of needle-like crystals of uric acid in connective tissue, joint spaces, or both. These deposits lead to inflammatory arthritis, causing swelling, redness, heat, pain, and stiffness in the joints. On the other hand, Osteoarthritis (OA) is not an autoimmune disease. It is a condition of wear and tear associated with aging or injury

The worst for people with gout are anchovies, codfish, haddock, herring, mackerel, mussels, roe (fish eggs), sardines, scallops, and trout. Salmon appears to be an exception and a better choice. While women had similar clinical features in terms of acute gout presentation (e.g., podagra, oligoarthritis, etc), and gouty arthritis (tophi, joint deformity), they were more likely to have contraindications to treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) (32% vs. 21%, p=0.02) or colchicine (14% vs. 6%, p=0.01) Gout (or monosodium urate [MSU] crystal deposition disease) is a crystal arthritis due to an oversaturation of uric acid (0.21-.42mmol/mol) which accumulates in the blood and then is deposited within joints most commonly, but also tendons, to cause a gouty arthritis The American College of Rheumatology (ACR) has updated its recommendations for managing gout, an inflammatory type of arthritis that affects an estimated 9.2 million adults in the United States.The 2020 guidelines update those issued in 2012, based on new evidence from recent studies and input from experts and patients Gout is one of the oldest known and most common forms of arthritis; it is a crystal deposition disease in which crystals of monosodium urate form in joints and other tissues. Gout attacks cause a characteristic painful inflammation of one or more joints of the extremities, or nodules in soft tissues called tophi.An acute attack of gout, although brief and usually subsiding spontaneously, can.

Gout is a type of arthritis that causes painful symptoms. There is no cure for gout, but people can manage the condition with medication and home remedies. Learn about the best home and natural. Acute gouty arthritis at the base of the big toe is referred to as podagra. Even without treatment, the first attacks stop spontaneously, typically within one to two weeks. While the pain and swelling completely go away, gouty arthritis commonly returns in the same joint or in another joint. tophi, can occur in the earlobe, elbow, and.

Tophi: Symptoms, Causes, Diagnosis, and Treatmen

Historically when gout produces a painful inflammation of the metatarsal-phalangeal joint at the base of the big toe the condition is referred to as podagra. Reproduced from Wikipedia Commons. Figure 2. Gouty inflammation in the first metatarsal-phalangeal joint , and tophi on the elbow of a middle aged male nurse . Reproduced from. However, podagra can also be caused by other etiologies, and psoriatic arthritis, reactive arthritis, and sarcoidosis should be ruled out. Gout can also manifest in the ankle, wrist, and knee. Initial gout attacks consist of a rapid onset of redness, swelling, and hypersensitivity that, if untreated, resolve in less than 2 weeks

The main aim of therapy for acute gout is rapid relief of pain and disability caused by intense inflammation, using nonsteroidal anti-inflammatory drugs, colchicine, glucocorticoids, and. All patients showed normal SUA and creatinine levels and none had a history of podagra or arthritis elsewhere. (all men, mean age 70.8 years) with acute gouty attack (acute arthritis in three, acute bursitis in two, subcutaneous tophi in four, associated with urate milk. Synovial effusions were thick, chalky, and appeared.

Gout is a disorder that causes sudden attacks of intense pain, swelling, and redness in your joints or soft tissues. In many cases, the first attacks occur in the joints of the big toe, but gout can affect many other joints. It is one type of inflammatory arthritis Gout is not a new disease, but its management has certainly seen much change in the past five years. It is increasingly being recognised as a serious disease that causes functional disability, increased work absence, and negative economic consequences for the individual and community. 1 Australian research indicates that gout is a significant and increasing problem, with at least 1.5% of the. Chronic gout 1. CHRONIC GOUT THE DISEASE OF KINGS Presented by : Dr. Emir 2. History > Podagra first identified by Egyptian > 5th Century BC : Hippocrates referred gout as unwalkable disease > The word gout derived from Latin word - gutta > Earlier it was believed that an acute attack was the result of poison dropping into the join Gout is a type of arthritis that happens when uric acid, a normal body waste, gets too high in the blood. Gout usually happens on the joints, fingers, and the upper ear. Find information about Gout risk factors, treatment, signs and symptoms. Learn about testing, diagnosis, and supplements for Gout Podagra; Use Additional. M1A.9XX1 Chronic gout, unspecified, with tophus (tophi... M1A.-) Clinical Information. A condition marked by increased levels of uric acid in the blood, joints, and tissue. The buildup of uric acid in the joints and tissues causes arthritis and inflammation

Gout is a monosodium urate crystal deposit disease, occurring as a consequence of hyperuricemia. Very importantly, the formation of crystals is reversible and they slowly dissolve when serum urate levels became normal, so the disease can be considered curable. The identification of urate crystals in synovial fluid allows simple unequivocal. Dual-energy CT (DECT) detection of monosodium urate (MSU) crystal deposition has demonstrated good sensitivity and specificity in patients with established gout. However, limitations have been reported with early disease and with low urate burden. We aimed to study the performance of DECT in the detection and quantification of MSU deposition in solid and liquid tophi 2 weeks, podagra, tophi, and rapid response to colchicine treatment, defined as a major reduction in the objective signs of inflamma-tion within 48 hours. The Rome prediction rule requires meet-ing 2 of 3 criteria: serum uric acid >7 mg/dL in men and >6 mg/dL in women, presence of tophi, and history of attacks of painful join The major symptoms are intense joint paint which subsides to inflammation, redness and discomfort. The signs and symptoms of gout include: • Intense joint pain: gout often impacts the large joint of the big toe, yet it could happen in the ankles, feet, hands, and wrists. The pain tends to be most severe in the first 4-12 hours after its start Ultrasound scores decreased with decreasing urate levels at 3, 6, and 12 months, with the highest numeric difference from baseline seen at 12 months for DC (3.1, 2.3, and 1.2; all P less than .001 vs. baseline of 4.2). The respective values for tophi were 6.3, 5.4, and 4.2 versus a baseline of 6.5; for aggregates, the values were 8.8, 7.9, and.

Symptoms characteristic of gout include: Acute joint pain: Discomfort is intense and most commonly affects the large joint of the big toe (known as podagra), but can also occur in the feet, ankles, knees, wrists and hands. Pain is most intense or severe between 4 and 12 hours after a gout attack occurs. Pain, at its worst, is so acute that any. These lumps are called tophi. Gout (Elbow) Some of the larger joints of the body have a fluid-filled sac around them that act as a shock absorber called a bursa. A bursa also helps with the movement mechanics of the joint. If gout causes inflammation and swelling of the bursa it is called bursitis Gout is a type of inflammatory arthritis caused by the deposition of monosodium urate (MSU) crystals in tissues and joints as a result of persistent hyperuricemia. The condition includes acute attacks of joint swelling and pain, followed by periods of remission. Progression to chronic gout may be accompanied by accumulation of MSU crystals, also called tophi, in joints or other soft tissue Ultrasound Can be Useful in Diagnosing Gout. Trained observers performed the crystal identification. The observers were required to pass a certification test involving a Web-based evaluation and the examination of five vials of synovial fluid. Ultrasound was also performed on at least one clinically affected joint among SUGAR study subjects