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1. Gout is caused by an excess of uric acid in the serum with deposition of monosodium urate crystals into joints, causing recurrent bouts of acute arthritis and, ultimately, chronic arthropathy.

2. Acute gout usually presents after 10-30 years of sustained hyperuricemia-in male patients > 40 years of age and after menopause in females (estrogen appears to be a uricosuric agent).

3. Excess uric acid (UA) is caused by either decreased renal excretion (under-excretors; 90%), its increased production (over-producers; < I0%), or a combination of the two.

4. To determine whether a patient is an "under-excretor" or an "over-producer," measure the amount of UA in the urine over 24 hours.

5. Under-excretors have low-to-normal 24-hour urine UA levels in the setting of increased serum levels.

6. Diagnosis is made by finding intracellular monosodium urate crystals.


1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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