Gout clinical stages and manifestations Gout is a crystal-associated arthropathy caused by monosodium urate (MSU) deposition, directly related to hyperuricemia due to disorders of purine metabolism and/or decreased uric acid excretion, specifically acute characteristic arthritis and chronic gouty stone disease, mainly including acute onset arthritis, gouty stone formation, gouty stone chronic arthritis, uric acid nephropathy and uric acid urinary tract stones. In severe cases, joint disability and renal insufficiency may occur. Gout is often associated with abdominal obesity, hyperlipidemia, hypertension, type 2 diabetes mellitus and cardiovascular disease. It is most common in men >40 years of age and in women after menopause, and often has a family history. Asymptomatic phase. There is only fluctuating or persistent hyperuricemia, and the time from elevated blood uric acid to the onset of symptoms can be years to decades, with some remaining asymptomatic for life, but the prevalence of gout increases with age and is related to the level and duration of hyperuricemia. Acute arthritic phase. Sudden onset at midnight or early in the morning, with severe pain, redness, swelling, heat, pain and dysfunction of the affected joints within a few hours, unilateral hallux valgus and 1st metatarsal phalangeal joint being the most common, the rest being ankle, knee, wrist, finger and elbow joints in that order; after colchicine treatment, arthritic symptoms can be rapidly relieved; fever; the initial attack is often self-limiting and resolves on its own within a few days, when the local skin of the affected joints appears to be flaky and The first attack is often self-limiting and resolves on its own within a few days, at which time the skin of the affected joints becomes flaky and itchy, which is a unique manifestation of the disease. Cold, exertion, alcohol consumption, high protein and purine diet, trauma, surgery and infection are all common triggers for the development of the disease. Gout stones and chronic arthritic phase. Gout stones are the characteristic clinical manifestation of gout, commonly found in the olecranon, metatarsophalangeal, interphalangeal and metacarpophalangeal joints, often with multi-joint involvement, mostly in the distal part of the joint, manifesting as joint swelling, stiffness, deformity and fibrosis and degeneration of the surrounding tissues. When a fistula is formed, the surrounding tissue is chronically granulomatous and rarely becomes infected, although it does not heal easily. Renal lesions Gouty nephropathy. Gout nephropathy has an insidious onset, with only intermittent proteinuria in the early stages, but persistent as the disease progresses, with increased nocturia when renal concentration is impaired. A small number of patients present with acute renal failure, with oliguria or anuria and an initial 24
The first 24 h of uric acid excretion is increased. Uric acid nephrolithiasis. 10% to 25% of patients with gout have uric acid stones in the kidney, which are mucoid and often asymptomatic, while larger stones may cause renal colic and hematuria. When stones cause obstruction it leads to hydronephrosis, pyelonephritis, pus accumulation in the kidney or perinephritis. Infection can accelerate the growth of stones and damage to the kidney parenchyma.