Clinical features of chronic gout
Rothenbacher, 2011Roughley, 2015Singh, 2011
If gout remains untreated, recurrent attacks may fail to resolve completely, slowly leading to a chronic disabling, destructive arthritis. Even in the absence of recognised recurrent attacks, urate crystals can deposit in the joints, soft tissues and kidneys, leading to joint damage and chronic kidney disease.
Chronic gout may be oligoarticular or polyarticular, and symmetrical involvement of the small joints of the hands can mimic rheumatoid arthritis and psoriatic arthritis. Serum uric acid concentration may also be elevated in psoriasis due to increased cell turnover, which further complicates the differential diagnosis of psoriatic arthritis1.
Chronic gout may be the first diagnosed clinical presentation of gout in some patients because of unrecognised previous acute attacks. Patients with chronic gout can also experience acute attacks (acute-on-chronic gout).
Gouty tophi are frequently seen in patients with chronic gout. They are usually present in the elbows (olecranon bursae), knees (prepatellar bursae) and peripheral joints (eg the toes and fingers). Chronic tophaceous gout is destructive and, unless treated, may cause significant disability.