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Joint Clinical Consensus Statement of the American College of Foot and Ankle Surgeons® and the American Association of Nurse Practitioners®: Etiology, Diagnosis, and Treatment Consensus for Gouty Arthritis of the Foot and Ankle

      Abstract

      Gout is a condition that commonly affects the foot and ankle, and practitioners who treat these structures should be aware of the methods to diagnose and treat this form of arthritis. Practitioners also need to recognize extra-articular manifestations of the disease. Although the acutely red, hot, swollen joint is a common presentation, chronic tophaceous gout can be associated with pain, nodule formation, and cutaneous compromise. Since the underlying causes that lead to excessive monosodium urate deposition may be treatable, early and accurate diagnosis can be very beneficial and may even prevent articular degeneration.

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      References

        • Dalkey NC
        • Helmer O
        An experimental application of the Delphi method to the use of experts.
        Manage Sci. 1963; 9: 458-467
        • Park RE
        • Fink A
        • Brook RH
        • Chassin MR
        • Kahn KL
        • Merrick NJ
        • Kosecoff J
        • Solomon DH
        Physician ratings of appropriate indications for six medical and surgical procedures.
        Am J Public Health. 1986; 76: 766-772
        • Elfishawi MM
        • Zleik N
        • Kvrgic Z
        • Jr MichetCJ
        • Crowson CS
        • Matleson EL
        • Bongartz T
        The rising incidence of gout and increasing burden of comorbidities: a population-based study over 20 years.
        J Rheumatol. 2018; 45: 574-579
        • Johnson RJ
        • Bakris GL
        • Borgi C
        • Chonchol MB
        • Feldman D
        • Lanaspa MA
        • Merriman TR
        • Moe OW
        • Mount DB
        • Sanchez Lozada LG
        • Stahl E
        • Weiner DE
        • Chertow GM
        Hyperuricemia, acute and chronic kidney disease, hypertension, and cardiovascular disease: report of a scientific workshop organized by the National Kidney Foundation.
        Am J Kidney Dis. 2018; (Feb 26. pii:S0272-6386(18)30087-8. doi:10.1053/j.ajkd.2017.12.009. [Epub ahead of print])
        • Zhu Y
        • Pandya BJ
        • Choi HK
        Comorbidities of gout and hyperuricemia in the US general population: NHANES, 2007-2008.
        Am J Med. 2012; 125: 679-687
        • Choi HK
        • Atkinson K
        • Karlson EW
        • Curhan G
        Obesity, weight change, hypertension, diuretic use, and risk of gout in men: the health professionals follow-up study.
        Arch Intern Med. 2005; 165: 742-748
        • Mandal AK
        • Mount DB
        The molecular physiology of uric acid homeostasis.
        Annu Rev Physiol. 2015; 77: 323-445
        • Choi HK
        • Soriano LC
        • Zhang Y
        • Rodriguez LA
        Antihypertensive drugs and risk of incident gout among patients with hypertension: population-based case-control study.
        BMJ. 2012; 344: d8190
        • Hunter DJ
        • York M
        • Chaisson CE
        • Woods R
        • Niu J
        • Zhang Y
        Recent diuretic use and the risk of recurrent gout attacks: the online case-crossover gout study.
        J Rheumatol. 2006; 33: 1341-1345
        • Bruderer S
        • Bodmer M
        • Jick SS
        • Meier CR
        Use of diuretics and risk of incident gout: a population-based case-control study.
        Arthritis Rheumatol. 2014; 66: 185-196
        • Nakanishi N
        • Suzuki K
        • Kawashimo H
        • Nakamura K
        • Tatara K
        Serum uric acid: correlation with biological, clinical and behavioral factors in Japanese men.
        J Epidemiol. 1999; 9: 99-106
        • Choi HK
        • Curhan G
        Beer, liquor and wine consumption and serum uric acid level: the Third National Health and Nutrition Examination Survey.
        Arthritis Rheum. 2004; 51: 1023-1029
        • Sharpe CR
        A case-control study of alcohol consumption and drinking behaviour in patients with acute gout.
        Can Med Assoc J. 1984; 131: 563-567
        • Zhang Y
        • Woods R
        • Chaisson CE
        • Neogi T
        • Niu J
        • McAlindon TE
        • Hunter D
        Alcohol consumption as a trigger of recurrent gout attacks.
        Am J Med. 2006; 119: 13-18
        • Neogi T
        • Chen C
        • Niu J
        • Chaisson C
        • Hunter DJ
        • Zhang Y
        Alcohol quantity and type on risk of recurrent gout attacks: an internet-based case-crossover study.
        Am J Med. 2014; 127: 311-318
        • Zhao Li
        • Xiaofan Guo
        • Yamin Liu
        • Ye Chang
        • Yingxian Sun
        • Guangshuo Zhu
        • Abraham MR
        The relation of moderate alcohol consumption to hyperuricemia in a rural general population.
        Int J Environ Res Public Health. 2016; 13: 732-744
        • Hak AE
        • Choi HK
        Menopause, postmenopausal hormone use and serum uric acid levels in US women—the Third National Health and Nutrition Examination Survey.
        Arthritis Res Ther. 2008; 10R: 116-123
        • Choi HK
        • Atkinson K
        • Karlson EW
        • Willett W
        • Curhan G
        Alcohol intake and risk of incident gout in men: a prospective study.
        Lancet. 2004; 363: 1277-1281
        • Choi HK
        • Atkinson K
        • Karlson EW
        • Willett W
        • Curhan G
        Purine-rich foods, dairy and protein intake, and the risk of gout in men.
        N Engl J Med. 2004; 350: 1093-1103
        • Waslien CI
        • Calloway DH
        • Margen S
        Uric acid production of men fed graded amounts of egg protein and yeast nucleic acid.
        Am J Clin Nutr. 1968; 21: 892-897
        • Choi HK
        • Curhan G
        Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study.
        BMJ. 2008; 336: 309-312
        • Batt C
        • Phipps-Green AJ
        • Black MA
        • Cadzow M
        • Merriman ME
        • Topless R
        • Gow P
        • Harrson A
        • Highton J
        • Jones P
        • Stamp L
        • Dalbeth N
        • Merriman TR
        Sugar-sweetened beverage consumption: a risk factor for prevalent gout with SLC2A9 genotype-specific effects on serum urate and risk of gout.
        Ann Rheum Dis. 2014; 73: 2101-2106
        • Bhole V
        • de Vera M
        • Rahman MM
        • Krishnan E
        Choi H. Epidemiology of gout in women: fifty-two-year follow up of a prospective cohort.
        Arthritis Rheum. 2010; 62: 1069-1076
        • Harrold LR
        • Etzel CJ
        • Gibofsky A
        • Kremer JM
        • Pillinger MH
        • Saag KG
        • Schlesinger N
        • Terkeltaub R
        • Cox V
        • Greenberg JD
        Sex differences in gout characteristics: tailoring care for women and men.
        BMC Musculoskel Disord. 2017; 18: 108-113
        • Cea Soriano L
        • Rothenbacher D
        • Choi HK
        • Garcia Rodriguez LA
        Contemporary epidemiology of gout in the UK general population.
        Arthritis Res Ther. 2011; 13: R39
        • Kuo CF
        • Grainge MJ
        • Zhang W
        • Doherty M
        Global epidemiology of gout: prevalence, incidence and risk factors.
        Nat Rev Rheumatol. 2015; 11: 649-662
        • Lin KC
        • Lin HY
        • Chou P
        The interaction between uric acid level and other risk factors on the development of gout among asymptomatic hyperuricemic men in a prospective study.
        J Rheumatol. 2000; 27: 1501-1505
        • Gibson T
        • Rodgers AV
        • Simmonds HA
        • Court-Brown F
        • Todd E
        • Meilton V
        A controlled study of diet in patients with gout.
        Ann Rheum Dis. 1983; 42: 123-127
        • Lewis HB
        • Doisy EA
        Studies in uric acid metabolism. I. The influence of high protein diets on the endogenous uric acid elimination.
        J Biol Chem. 1918; 36: 1-7
        • Raiziss GW
        • Dubin H
        • Ringer AI
        Studies in endogenous uric acid metabolism.
        J Biol Chem. 1914; 19: 473-485
        • Perheentupa J
        • Raivio K
        Fructose-induced hyperuricemia.
        Lancet. 1967; 2: 528-531
        • Fox IH
        • Kelley WN
        Studies on the mechanism of fructose-induced hyperuricemia in man.
        Metabolism. 1972; 21: 713-721
        • Choi HK
        • Curhan G
        Coffee consumption and risk of incident gout in women: the Nurses’ Health Study.
        Am J Clin Nutr. 2010; 92: 922-927
        • Choi HK
        • Willet W
        • Curhan G
        Coffee consumption and risk of incident gout in men: a prospective study.
        Arthritis Rheum. 2007; 56: 2049-2055
        • Kela U
        • Vijayvargiya R
        • Trivedi CP
        Inhibitory effects of methylxanthines on the activity of xanthine oxidase.
        Life Sci. 1980; 27: 2109-2119
        • Lyu LC
        • Hsu CY
        • Yeh CY
        • Lee MS
        • Huang SH
        • Chen CL
        A case-control study of the association of diet and obesity with gout in Taiwan.
        Am J Clin Nutr. 2003; 78: 690-701
        • Zhang Y
        • Neogi T
        • Chen C
        • Chaisson C
        • Hunter DJ
        • Choi HK
        Cherry consumption and decreased risk of recurrent gout attacks.
        Arthritis Rheum. 2012; 64: 4004-4011
        • Choi HK
        • Gao X
        • Curhan G
        Vitamin C intake and the risk of gout in men: a prospective study.
        Arch Intern Med. 2009; 169: 502-507
        • Garrel DR
        • Verdy M
        • PetitClerc C
        • Martin C
        • Brule D
        • Hamet P
        Milk- and soy-protein ingestion: acute effect on serum uric acid concentration.
        Am J Clin Nutr. 1991; 53: 665-669
        • Emmerson B
        Hyperlipidaemia in hyperuricaemia and gout.
        Ann Rheum Dis. 1998; 57: 509-510
        • Snaith ML
        Gout: diet and uric acid revisited.
        Lancet. 2001; 358: 52
        • Fam AG
        Gout, diet, and the insulin resistance syndrome.
        J Rheumatol. 2002; 29: 1350-1355
        • Karis E
        • Crittenden DB
        • Pillinger MH
        Hyperuricemia, gout, and related comorbidities: cause and effect on a two-way street.
        South Med J. 2014; 107: 235-241
        • Bevis M
        • Blagojevic-Bucknall M
        • Mallen C
        • Hider S
        • Roddy E
        Comorbidity cluster in people with gout: an observational cohort study with linked medial record review.
        Rheumatology (Oxford). 2018; (Apr 17. doi:10.1093/rheumatology/key096. [Epub ahead of print])
        • Annemans L
        • Spaepen E
        • Gaskin M
        • Bonnemaire M
        • Malier V
        • Gilbert T
        • Nuki G
        Gout in the UK and Germany: prevalence, comorbidities and management in general practice 2000-2005.
        Ann Rheum Dis. 2008; 67: 960-966
        • Kim SC
        • Liu J
        • Solomon DH
        Risk of incident diabetes in patient with gout: a cohort study.
        Arthritis Rheumatol. 2015; 67: 273-280
        • Dehghan A
        • van Hoek M
        • Sijbrands EJ
        • Hofman A
        • Witteman JC
        High serum uric acid as a novel risk factor for type 2 diabetes.
        Diabetes Care. 2008; 31: 361-362
        • Kramer CK
        • von Muhlen D
        • Jassal SK
        • Barrett-Connor E
        Serum uric acid levels improve prediction of incident type 2 diabetes in individuals with impaired fasting glucose: the Rancho Bernardo Study.
        Diabetes Care. 2009; 32: 1272-1273
        • Niskanen L
        • Laaksonen DE
        • Lindstrom J
        • Eriksson JG
        • Keinanen-Kiukaanniemi S
        • Ilanne-Parikka P
        • Aunola S
        • Hamalainen H
        • Tuomilehto J
        • Uusitupa M
        Serum uric acid as a harbinger of metabolic outcome in subjects with impaired glucose tolerance: the Finnish Diabetes Prevention Study.
        Diabetes Care. 2006; 29: 709-771
        • Lai HM
        • Chen CJ
        • Su BY
        • Chen YC
        • Yu SF
        • Yen JH
        • Hsieh MC
        • Cheng TT
        • Change SJ
        Gout and type 2 diabetes have a mutual inter-dependent effect on genetic risk factors and higher incidences.
        Rheumatology. 2012; 51: 715-720
        • Kuo CF
        • Luo SF
        • See LC Chou IJ
        • Fang YF
        • Yu KH
        Increased risk of cancer among gout patients: a nationwide population study.
        Joint Bone Spine. 2012; 79: 375-378
        • Baeksgaard L
        • Sorensen JB
        Acute tumor lysis syndrome in solid tumors: a case report and review of the literature.
        Cancer Chemother Pharmacol. 2003; 51: 187-192
        • Wannamethee SG
        Serum uric acid and risk of coronary heart disease.
        Curr Pharmaceutical Design. 2005; 11: 4125-4132
        • Mirrakhimov AE
        • Ali AM
        • Khan M
        • Barbaryan A
        Tumor lysis syndrome in solid tumors: an up to date review of the literature.
        Rare Tumors. 2014; 6: 68-74
        • Wang W
        • Xu D
        • Wang B
        • Yan S
        • Wang X
        • Yin Y
        • Wan X
        • Sun B
        • Sun X
        Increased risk of cancer in relation to gout. A review of three prospective cohort studies with 50,358 patients.
        Mediators Inflamm. 2015; 2015680853https://doi.org/10.1155/2015/680853
        • Chen CJ
        • Yen JH
        • Chang SJ
        Gout patients have an increased risk of developing most cancers, especially urological cancers.
        Scand J Rheum. 2014; 43: 385-390
        • Fini MA
        • Elias A
        • Johnson RJ
        • Wright RM
        Contribution of uric acid to cancer risk, recurrence and mortality.
        Clinl Transl Med. 2012; 1: 1-16
        • Boffetta P
        • Nordenvall C
        • Nyren O
        • Ye W
        A prospective study of gout and cancer.
        Europ J Cancer Prev. 2009; 18: 127-132
        • Alexandrescu DT
        • Ichim TE
        • Kabigting F
        • Dasanu CA
        Acute gout during treatment with paclitaxel for metastatic melanoma.
        Rheumatology. 2009; 48: 862-863
        • Bottiglieri S
        • Tierson N
        • Patel R
        • Mo MO
        • Mehdi S
        Gemcitabine-induced gouty arthritis attacks.
        J Oncol Pharm Prac. 2013; 19: 284-288
      1. Acute gout arthritis attacks in an elderly patient: case report.
        Reactions Weekly. 2013; 77: 1469
        • Peixoto RD
        • Cossetti R
        • Lim H
        • Cheung WY
        • Kennecke H
        Acute gout episodes during treatment with capecitabine: a case report.
        Gastrointest Cancer Res. 2014; 7: 59-60
        • Abhishek A.
        Managing gout flares in the elderly: practical considerations.
        Drugs Aging. 2017; 34: 873-880
        • De Souza AW
        • Fernandes V
        • Ferrari AJ
        Female gout: clinical and laboratory features.
        J Rheumatol. 2005; 32: 2186-2188
        • Juraschek SP
        • Miller 3, ER
        • Gelber AC
        Body mass index, obesity, and prevalent gout in the United States in 1988-1994 and 2007-2010. Body mass index, obesity and gout.
        Arthritis Care Res (Hoboken). 2013; 65: 127-132
        • Chen JH
        • Yeh WT
        • Chuang SY
        • Wu YY
        • Pan WH
        Gender-specific risk factors for incident of gout: A prospective cohort study.
        Clin Rheumatol. 2012; 31: 239-245
        • Ozturk MA
        • Kaya A
        • Senel S
        • Donmez S
        • Balkarli A
        • Cobankara V
        • Erhan C
        • Sayarlioglu M
        • Ugan Y
        • Tunc SE
        • Pehlivan Y
        • Kisacik B
        • Tufan A
        • Onat AM
        • Tezcan E
        • Yildirim Cetin G
        • Pamuk ON
        Demographic and clinical features of gout patients in Turkey: a multi center study.
        Rheumatol Int. 2013; 33: 847-852
        • Puig JG
        • Michan AD
        • Jimenez ML
        • Perez de Ayala C
        • Mateos FA
        • Capitan CF
        • de Miguel E
        • Gijon JB
        Female gout. Clinical spectrum and uric acid metabolism.
        Arch Intern Med. 1991; 151: 726-732
        • Currie WJ
        Prevalence and incidence of the diagnosis of gout in Great Britain.
        Ann Rheum Dis. 1979; 38: 101-106
        • Harris CM
        • Lloyd DC
        • Lewis J
        The prevalence and prophylaxis of gout in England.
        J Clin Epidemiol. 1995; 48: 1153-1158
        • Hak AE
        • Curhan GC
        • Grodstein F
        • Choi HK
        Menopause, postmenopausal hormone use and risk of incident gout.
        Ann Rheum Dis. 2010; 6: 1305-1309
        • Abbott RD
        • Brand FN
        • Kannel WB
        • Castelli WP
        Gout and coronary heart disease: the Framingham Study.
        J Clin Epidmiol. 1988; 41: 237-242
        • Brauer GW
        • Prior IA
        A prospective study of gout in New Zealand Maoris.
        Ann Rheum Dis. 1978; 37: 466-472
        • Stewart OJ
        • Silman AJ
        Review of UK data of the rheumatic diseases- gout.
        Br J Rheumatol. 1990; 29: 485-488
        • Arrmodee E
        • Michet CJ
        • Crowson CS
        • O'Fallon WM
        • Gabriel SE
        Epidemiology of gout: is the incidence rising?.
        J Rheumatol. 2002; 29: 2403-2406
        • Mikuls TR
        • Farrar JT
        • Bilker WB
        • Fernandes S
        • Jr SchumacherHR
        • Saag KG
        Gout epidemiology: results from the UK General Practice Research Database, 1990-1999.
        Ann Rheum Dis. 2005; 64: 267-272
        • Hanova P
        • Pavelka K
        • Dostal C
        • Holcatova I
        • Pikhart H
        Epidemiology of rheumatoid arthritis, juvenile idiopathic arthritis and gout in two regions of the Czech Republic in a descriptive population-based survey in 2002-2003.
        Clin Exp Rheumatol. 2006; 24: 499-507
        • Elliott AJ
        • Cross KW
        • Fleming DM
        Seasonality and trends in the incidence and prevalence of gout in England and Wales 1994-2007.
        Ann Rheum Dis. 2009; 68: 1728-1733
        • Phipps-Green AJ
        • Hollis-Moffatt JE
        • Dalbeth N
        • Merriman ME
        • Topless R
        • Gow PJ
        • Harrison AA
        • Highton J
        • Jones PB
        • Stamp LK
        • Merriman TR
        A strong role for the ABCG2 gene in susceptibility to gout in New Zealand Pacific Island and Caucasian, but not Maori, case and control sample sets.
        Hum Mol Genet. 2010; 19: 4813-4819
        • Primatesta P
        • Plana E
        • Rothenbacher D
        Gout treatment and comorbidities: a retrospective cohort study in a large US managed care population.
        BMC Musculoskeletal Disorders. 2011; 12: 103-109
        • Trifiro G
        • Morabito P
        • Cavagna L
        • Ferrajolo C
        • Pecchioli S
        • Simonetti M
        • Bianchini E
        • Medea G
        • Cricelli C
        • Caputi AP
        • Mazzaglia G
        Epidemiology of gout and hyperuricaemia in Italy during the years 2005-2009: a nation-wide population-based study.
        Am Rheum Dis. 2013; 72: 694-700
        • Kuo CF
        • Grainge MJ
        • Mallen C
        • Zhang W
        • Doherty M
        Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study.
        Ann Rheum Dis. 2015; 74: 661-667
        • Kuo CF
        • Grainge MJ
        • See LC
        • YU KH
        • LUO SF
        • Zhang W
        • Doherty M
        Epidemiology and management of gout in Taiwan: a nationwide population study.
        Arthritis Res Ther. 2015; 17: 13-22
        • Roubenoff R
        • Klag MJ
        • Mead LA
        • Liang KY
        • Seidler AJ
        • Hochberg MC
        Incidence and risk factors for gout in white men.
        JAMA. 1991; 266: 3004-3007
        • Nielsen SM
        • Bartels EM
        • Henriksen M
        • et al.
        Weight loss for overweight and obese individuals with gout: a systematic review of longitudinal studies.
        Ann Rheum Dis. 2017; 76: 1870-1882
        • Romero-Talamás H
        • Daigle CR
        • Aminian A
        • Corcelles R
        • Brethauer SA
        • Schauer PR
        The effect of bariatric surgery on gout: a comparative study.
        Surg Obes Relat Dis. 2014; 10: 1161-1165
        • Zhu Y
        • Pandya BJ
        • Choi HK
        Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008.
        Arthritis Rheum. 2011; 63: 3136-3141
        • Hochberg MC
        • Thomas J
        • Thomas DJ
        • Mead L
        • Levine DM
        • Klag MJ
        Racial differences in the incidence of gout.
        The role of hypertension. Arthritis Rheum. 1995; 38: 628-632
        • McAdams MA
        • Maynard JW
        • Baer AN
        • Kottgen A
        • Clipp S
        • Coresh J
        • Gelber AC
        Reliability and sensitivity of the self-report of physician-diagnosed gout in the campaign against cancer and heart disease and the atherosclerosis risk in the community cohorts.
        J Rheumatol. 2011; 38: 135-141
        • Coley K
        • Saul M
        • Pater K
        Relationship between race, uric acid levels, urate-lowering therapy and resource use in patients with gout.
        Arthritis Rheum. 2012; 64: S772
        • Krishnan E
        • Lienesch D
        • Kwoh CK
        Gout in ambulatory care settings in the United States.
        J Rheumatol. 2008; 35: 498-501
        • Khanna D
        • Fitzgerald JD
        • Khanna PP
        • Bae S
        • Singh MK
        • Neogi T
        • Pillinger MH
        • Merill J
        • Lee S
        • Prakash S
        • Kaldas M
        • Gogia M
        • Perez-Ruiz F
        • Taylor W
        • Liote F
        • Choi H
        • Singh JA
        • Dalbeth N
        • Kaplan S
        • Niyyar V
        • Jones D
        • Yarows SA
        • Roessler B
        • Kerr G
        • King C
        • Levy G
        • Furst DE
        • Edwards NL
        • Mandell B
        • Schumacher HR
        • Robbins M
        • Wenger N
        • Terkeltaub R
        American College of Rheumatology. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia.
        Arthritis Care Res (Hoboken). 2012; 64: 1431-1446
        • Chou H
        • Chin TY
        • Peh WCG
        Dual‐energy CT in gout – a review of current concepts and applications.
        J Med Rad Sci. 2017; 64: 41-45
        • Liddle J
        • Roddy E
        • Mallen CD
        • Hider SL
        • Prinjha S
        • Ziebland S
        • Richardson JC
        Mapping patients' experiences from initial symptoms to gout diagnosis: a qualitative exploration.
        Br Med J Open. 2015; 5: 1-7
        • Richette P
        • Doherty M
        • Pascual E
        • Barskova V
        • Becce F
        • Castaneda-Sanabria J
        • Coyfish M
        • Guillo S
        • Jansen TL
        • Janssens H
        • Liote F
        • Mallen C
        • Nuki G
        • Perez-Ruiz F
        • Pimentao J
        • Punzi L
        • Pywell T
        • So A
        • Ak Tausche
        • Uhlig T
        • Zavada J
        • Zhang W
        • Tubach F
        • Bardin T
        2016 updated EULAR evidence-based recommendations for the management of gout.
        Ann Rheum Dis. 2017; 76: 29-42
        • Neogi T
        Gout.
        New Engl J Med. 2011; 364: 443-452
      2. Popovich I, Dalbeth N, Doyle A, Reeves Q, McQueen FM. Exploring cartilage damage in gout using 3-T MRI: distribution and associations with joint inflammation and tophus deposition. Skeletal Radiol 2014;43:917–924.

      3. Rothschild BM, Miller AV, Francise ML. Gout and pseudogout. Available at: https://emedicine.medscape.com/article/329958-overview. Accessed August 28, 2018.

        • Roseff R
        • Wohlgethan JR
        • Sipe JD
        • Canoso JJ
        The acute phase response in gout.
        J Rheumatol. 1987; 4: 974-977
        • Ragab G
        • Elshahaly M
        • Bardin T
        Gout: an old disease in a new perspective – a review.
        J Adv Res. 2017; 8: 495-511
      4. Smelser CD. Gout imaging. Available at:https://emedicine.medscape.com/article/389965-overview. Accessed August 28, 2018.

        • Chhana A
        • Doyle A
        • Sevao A
        • Amirapu S
        • Riordan P
        • Dray M
        • McGlashan D
        • Cornish J
        • Dalbeth N
        Advanced imaging assessment of gout: Comparison of dual-energy CT and MRI with anatomical pathology.
        Ann Rheum Dis. 2018;; 77: 629-630
        • Qaseem A
        • McLean RM
        • Starkey M
        • Forciea MA
        Diagnosis of acute gout: a clinical practice guideline from the American College of Physicians.
        Ann Int Med. 2017; 166: 52-57
        • Villaverde V
        • Rosario MP
        • Loza E
        • Perez F
        Systematic review of the value of ultrasound and magnetic resonance musculoskeletal imaging in the evaluation of response to treatment of gout.
        Rheumatol Clin. 2014; 10: 160-163
        • Neogi T
        • Jansen TLTA
        • Dalbeth N
        • Fransen J
        • Schumacher HR
        • Berendsen D
        • Brown M
        • Choi H
        • Edwards L
        • Janssens HJEM
        • Liote F
        • Naden RP
        • Nuki G
        • Ogdie A
        • Perez-Ruiz F
        • Saag K
        • Singh JA
        • Sundy JS
        • Tausche AK
        • Vaquez-Mellado J
        • Yarows SA
        • Taylor WJ
        Gout classification criteria. An American College of Rheumatology/European League Against Rheumatism Collaborative Initiative.
        Arthritis Rheum. 2015; 67: 2557-2568
        • Doherty M
        New insights into the epidemiology of gout.
        Rheumatology. 2009; 48: ii2-ii8
        • Martilo MA
        • Nazzal L
        • Crittenden DB
        The crystallization of monosodium urate.
        Curr Rheumatol Rep. 2014; 16: 400-412
        • Fitzgerald BT
        • Setty A
        • Mudgal CS
        Gout affecting the hand and wrist.
        J Am Acad Ortho Surg. 2007; 15: 625-635
        • Weinfeld SB
        • Schon LC
        Hallux metatarsophalangeal arthritis.
        Clin Ortho Rel Res. 1998; 349: 9-19
        • Hall AP
        • Barry PE
        • Dawber TR
        • McNamara PM
        Epidemiology of gout and hyperuricemia. A long-term population study.
        Am J Med. 1967; 42: 27-37
        • Fessel WJ
        • Siegelaub AB
        • Johnson ES
        Correlates and consequences of asymptomatic hyperuricemia.
        Arch Intern Med. 1973; 132: 44-54
      5. Schlesinger N. Gout. In: TM Buttaro, J Trybulski, P Polgar-Bailey, J SAndberg-Cook eds. Primary care: A collaborative practice. 5th ed., St. Louis, MO, Elsevier; 2016:929.

        • Swan A
        • Amer H
        • Dieppe P
        The value of synovial fluid assays in the diagnosis of joint disease: a literature survey.
        Ann Rheum Dis. 2002; 61: 493-498
        • Van Durme CM
        • Wechalekar MD
        • Buchbinder R
        • Schlesinger N
        • van der Heijde D
        • Landwew RB
        Non-steroidal anti-inflammatory drugs for acute gout.
        Cochrane Database Syst Rev. 2014; 16CD010120https://doi.org/10.1002/14651858.CD010120
        • Valdes EF
        Use of tenoxicam in patients with acute gouty arthritis.
        Eur J Rheumatol Inflamm. 1987; 9: 133-136
        • Man CY
        • Cheung IT
        • Cameron PA
        • Rainer TH
        Comparison of oral prednisolone/paracetamol and oral indomethacin/paracetamol combination therapy in the treatment of acute gout like arthritis: a double-blind, randomized controlled trial.
        Ann Emerg Med. 2007; 49: 670-677
        • Xu L
        • Liu S
        • Guan M
        • Xue Y
        Comparison of prednisolone, Etoricoxib, and indomethacin in treatment of acute gouty arthritis: an open-label, randomized control trial.
        Med Sci Monit. 2016; 22: 810-817
        • Billy CA
        • Lim RT
        • Ruospo M
        • Palmer SC
        • Strippoli GFM
        Corticosteroid or non-steroidal antiinflammatory drugs for the treatment of acute gout: a systematic review of randomized controlled trials.
        J Rheumatol. 2018; 45: 128-136
        • Wechalekar MD
        • Vinik O
        • Moi JH
        • Sivera F
        • van Echtled IA
        • van Durme C
        • Falzon L
        • Bombardier C
        • Carmona L
        • Aletaha D
        • Landewe RB
        • van der Heijde DM
        • Buchbinder R
        The efficacy and safety of treatments for acute gout: results from a series of systematic literature reviews including Cochrane reviews on intraarticular glucocorticoids, colchicine, nonsteroidal antiinflammatory drugs, and interleukin-1 inhibitors.
        J Rheumatol Suppl. 2014; 92: 15-25
        • Shrestha M
        • Moran DL
        • Moreden JM
        • Singh R
        • Nelson M
        • Hayes JE
        Randomized double-blind comparison of the analgesic efficacy of intramuscular ketorolac and oral indomethacin in the treatment of acute gouty arthritis.
        Ann Emerg Med. 1995; 26: 682-686
        • Qaseem A
        • Harris RP
        • Forciea MA
        Clinical Guidelines Committee of the American College of Physicians. Management of acute and recurrent gout: a clinical practice guideline from the American College of Physicians.
        Ann Intern Med. 2017; 166: 58-68
        • Wilson L
        • Saseen JJ
        Gouty arthritis: a review of acute management and prevention.
        Pharmacotherapy. 2016; 36: 906-922
        • Dalbeth N
        • Merriman TR
        • Stamp LK
        Gout.
        Lancet. 2016; 388: 2039-2052
        • Terkeltaub RA
        • Furst DE
        • Bennett K
        • Kook KA
        • Crockett RS
        • Davis MW
        High versus low dosing of oral colchicine for early acute gout flare: Twenty-four-hour outcome of the first multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-comparison colchicine study.
        Arthritis Rheum. 2010; 62: 1060-1068
        • Gutman A
        Gout and gouty arthritis.
        in: Beeson PB McDermott W Textbook of Medicine. eds. Saunders, Philadelphia1958
        • Terkeltaub RA
        Clinical practice. Gout.
        N Engl J Med. 2003; 349: 1647-1655
        • Khanna D
        • Fitzgerald JD
        • Khanna PP
        • Bae S
        • Singh MK
        • Neogi T
        • Pillinger MH
        • Merill J
        • Lee S
        • Prakash S
        • Kaldas M
        • Gogia M
        • Perez-Ruiz F
        • Taylor W
        • Liote F
        • Choi H
        • Singh JA
        • Dalbeth N
        • Kaplan S
        • Niyyar V
        • Jones D
        • Yarows SA
        • Roessler B
        • Kerr G
        • King C
        • Levy G
        • Furst DE
        • Edwards NL
        • Mandell B
        • Schumacher HR
        • Robbins M
        • Wenger N
        • Terkeltaub R
        American College of Rheumatology. 2012 American College of Rheumatology guidelines for management of gout. Part 2: therapy and antiinflammatory prophylaxis of acute gouty arthritis.
        Arthritis Care Res (Hoboken). 2012; 64: 1447-1461
        • Sivera F
        • Andres M
        • Carmona L
        • Kydd AS
        • Moi J
        • Seth R
        • Sriranganathan M
        • van Durme C
        • van Echteld I
        • Vinik O
        • Wechalekar MD
        • Aletaha D
        • Bombardier C
        • Buchbinder R
        • Edwards CJ
        • Landewe RB
        • Bijlsma JW
        • Brano JC
        • Burgos-Vargas R
        • Catria AI
        • Elwaut D
        • Ferrari AJ
        • Kiely P
        • Leeb BF
        • Montecucco C
        • Muller-Ladner U
        • Ostergaard M
        • Zochling J
        • Faizon L
        • van der Heijde DM
        Multinational evidence-based recommendations for the diagnosis and management of gout: integrating systematic literature review and expert opinion of a broad panel of rheumatologists in the 3e Initiative.
        Ann Rheum Dis. 2014; 73: 328-335
        • Fernandez C
        • Noguera R
        • Gonzalez JA
        • Pascual E
        Treatment of acute attacks of gout with a small dose of intraarticular triamcinolone acetonide.
        J Rheum. 1999; 26: 2285-2286
        • Kang MH
        • Moon KW
        • Jeon YH
        • Cho SW
        Sonography of the first metatarsophalangeal joint and sonographically guided intraarticular injection of corticosteroid in acute gout attack.
        J Clin Ultrasound. 2015; 43: 179-186
        • Wason S
        • Faulkner RD
        • Davis MW
        Colchicine dosing guidelines for gout patients with varying degrees or renal impairment based on pharmacokinetic data.
        Arthritis Rheum. 2011; 63 (Suppl): S1013
        • Werlen D
        • Gabay C
        • Vischer TL
        Corticosteroid therapy for the treatment of acute attacks of crystal-induced arthritis: an effective alternative to nonsteroidal anti-inflammatory drugs.
        Rev Rheum Engl Ed. 1996; 63: 248-254
        • Alloway JA
        • Moriarty MJ
        • Hoogland YT
        • Nashel DJ
        Comparison of triamcinolone acetonide with indomethacin in the treatment of acute gouty arthritis.
        J Rheumatol. 1993; 20: 111-113
        • Groff GD
        • Franck WA
        • Raddatz DA
        Systemic steroid therapy for acute gout: a clinical trial and review of the literature.
        Semin Arthritis Rheumatism. 1990; 19: 329-336
        • Jordan KM
        • Cameron JS
        • Snaith M
        • Zhang W
        • Doherty M
        • Seckl J
        • Hingorani A
        • Jaques R
        • Nuki G
        British Society for Rheumatology and British Health Professional in Rheumatology guideline for the management of gout.
        Rheumatology. 2007; 46 (1372–1274)
        • Nuki G
        • Doherty M
        • Richette P
        Current management of gout: practical messages from 2016 EULAR guidelines.
        Pol Arch Intern Med. 2017; 127: 267-277
        • Keith MP
        • Gilliland WR
        Updates in the management of gout.
        Am J Med. 2007; 120: 221-224
        • Hughes JC
        • Wallace JL
        • Bryant CL
        • Salvig BE
        • Fourakre TN
        • Stone WJ
        Monitoring of urage-lowering therapy among US Veterans following the 2012 American College of Rheumatology Guidelines for management of gout.
        Ann Pharmacother. 2017; 51: 301-306
        • Pulavarti RS
        • McVie JL
        • Tulloch CJ
        First metatarsophalangeal joint replacement using the bio-action great toe implant: intermediate results.
        Foot Ankle Int. 2005; 26: 1033-1037
        • Lemon B
        • Pupp GR
        Long-term efficacy of total SILASTIC implants: a subjective analysis.
        J Foot Ankle Surg. 1997; 36: 341-346
        • Seeber E
        • Knessl J
        Treatment of hallux rigidus with the TOEFITPLUS joint replacement system.
        Interactive Surg. 2007; 2: 77-85
        • Sorbie C
        • Saunders GA
        Hemiarthroplasty in the treatment of hallux rigidus.
        Foot Ankle Int. 2008; 29: 273-281
        • Dabdoub WH
        • Short LA
        • Cudas CJ
        Acute goutyarthritis in a first metatarsophalangeal joint replaced with a flexible-hinge implant: a case report.
        J Foot Surg. 1981; 20: 167-169
        • Bonet J
        • Taylor DT
        • Lam AT
        • Williams E
        • Keane LA
        Retrospective analysis of silastic implant arthroplasty of the first metatarsophalangeal joint.
        J Foot Ankle Surg. 1998; 37: 128-134
        • Barg A
        • Knupp M
        • Al Kapron
        • Hintermann B
        Total ankle replacement in patients with gouty arthritis.
        J Bone Joint Surg Am. 2011; 93: 357-366
        • Crawford L
        • Kumar A
        • Shepherd GJ
        Gouty arthritis after total knee arthroplasty: a case report.
        J Ortho Surg (Hong Kong). 2007; 15: 384-385
        • Berger J
        • Weinik M
        Acute gouty arthropathy mimicking infection after total knee arthroplasty.
        PM R. 2009; 1: 284-286
        • Wang LD
        • Yufei Z
        • Tang K
        Arthroscopic debridement for the diagnosis and treatment of gouty arthritis.
        Chin J Orthop. 1997; 17: 751-753
        • Wang CC
        • Lien SB
        • Huang GS
        • Pan RY
        • Shen HC
        • Kuo CL
        • Shen PH
        • Lee CH
        Arthroscopic elimination of monosodium urate deposition of the first metatarsophalangeal joint reduces the recurrence of gout.
        Arthroscopy. 2009; 25: 153-158
        • Li HL
        • Li SY
        • Li CB
        • Qui W
        • Qu F
        • Guo Q
        • Shen XZ
        • Lu X
        • Liu YJ
        • Wei M
        [Clinical observation of arthroscopic debridement for acute gouty arthritis of the ankle].
        Zhongguo Gu Shang. 2016; 29: 258-260
        • Yu KH
        • Chen DY
        • Chen JH
        • Chen SY
        • Chen SM
        • Cheng TT
        • Hsieh SC
        • Hsieh TY
        • Hsu PF
        • Kuo CF
        • Kuo MC
        • Lam HC
        • Lee IT
        • Liang TH
        • Lin HY
        • Lin SC
        • Tsai WP
        • Tsay GJ
        • Wei JC
        • Yang CH
        • Tsai WC
        Management of gout and hyperuricemia: multidisciplinary consensus in Taiwan.
        Int J Rheum Dis. 2018; 21: 772-787
        • McLachlan A
        • Kerr A
        • Lee M
        • Dalbeth N
        Nurse-led cardiovascular disease risk management intervention for patients with gout.
        Eur J Cardiovasc Nurs. 2011; 10: 94-100
        • Fields TR
        • Rifaat A
        • Yee AMF
        • Ashany D
        • Kim K
        • Tobin M
        • Oliva N
        • Fields K
        • Richey M
        • Kasturi S
        • Batterman A
        Pilot study of a multidisciplinary gout patient education and monitoring program.
        Semin Arthritis Rheum. 2017; 46: 601-608
      6. Fields TR, Batterman A. How can we improve disease education in people with gout? Curr Rheumatol Rep 2018;20:12–14.

        • Latif Z
        • Abbishek A
        Are doctors the best people to manage gout? Is there a role for nurses and pharmacists?.
        Curr Rheumatol Rep. 2018; 20: 14
        • Rees F
        • Jenkins W
        • Doherty M
        Patients with gout adhere to curative treatment if informed appropriately: proof-of-concept observational study.
        Ann Rheum Dis. 2013; 72: 826-830
        • Kamper SJ
        • Apeldoorn AT
        • Chiarotto A
        • Smeets RJ
        • Ostelo RW
        • Guzman J
        • van Tulder MW
        Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis.
        BMJ. 2015; 350: h444https://doi.org/10.1136/bmj/j444
        • Shen ZZ
        • Huang YY
        • Hsieh CJ
        Early short-term intensive multidisciplinary diabetes care: a ten-year follow-up of outcomes.
        Diabetes Res Clin Pract. 2017; 130: 133-141
        • Helou N
        • Dwyer A
        • Shaha M
        • Zanchi A
        Multidisciplinary management of diabetic kidney disease: a systematic review and meta-analysis.
        JBI Database System Rev Implement Rep. 2016; 14: 169-207
        • Murray C
        • Shaw A
        • Lloyd M
        • Smith RP
        • Fardon TC
        • Schembri S
        • Chalmers JD
        A multidisciplinary intervention to reduce antibiotic duration in lower respiratory tract infections.
        J Antimicrob Chemother. 2014; 69: 515-518
        • Forni S
        • Pieralli F
        • Sergi A
        • Lorini C
        • Bonaccorsi G
        • Vannucci A
        Mortality after hip fracture in the elderly: the role of a multidisciplinary approach and time to surgery in a retrospective observational study on 23,973 patients.
        Arch Gerontol Geriatr. 2016; 66: 13-17
        • Wang SM
        • Hsiao LC
        • Ting IW
        • Yu TM
        • Liang CC
        • Kuo HL
        • Chang CT
        • Liu JH
        • Chou CY
        • Huang CC
        Multidisciplinary care in patients with chronic kidney disease: a systematic review and meta-analysis.
        Eur J Intern Med. 2015; 26: 640-645
        • Shi Y
        • Xiong J
        • Chen Y
        • Deng J
        • Peng H
        • Zhao J
        • He J
        The effectiveness of multidisciplinary care models for patients with chronic kidney disease: a systematic review and meta-analysis.
        Int Urol Nephrol. 2018; 50: 301-312
        • Stewart S
        • Wiley JF
        • Ball J
        • Chan YK
        • Ahamed Y
        • Thompson DR
        • Carrington MJ
        Impact of nurse-led, multidisciplinary home-based intervention on event-free survival across the spectrum of chronic heart disease: composite analysis of health outcomes in 1226 patients from 3 randomized trials.
        Circulation. 2016; 133: 1867-1877
        • Dang W
        • Yi A
        • Jhamnani S
        • Wang SY
        Cost-effectiveness of multidisciplinary management program and exercise training program in heart failure.
        Am J Cardiol. 2017; 120: 1338-1343
        • Harold LR
        • Mazor KM
        • Peterson D
        • Naz N
        • Firneno C
        • Yood RA
        Patients’ knowledge and beliefs concerning gout and its treatment: a population based study.
        BMC Musculoskelet Disord. 2012; 13: 180-187
        • Chandratre P
        • Mallen CD
        • Roddy E
        • Liddle J
        • Richardson J
        You want to get on with the rest of your life: a qualitative study of health-related quality of life in gout.
        Clin Rheumatol. 2016; 35: 1197-1205
        • Shulten P
        • Thomas J
        • Miller M
        • Smith M
        • Ahern M
        The role of diet in the management of gout: a comparison of knowledge and attitudes to current evidence.
        J Hum Nutr Diet. 2009; 22: 3-11
        • Yin R
        • Li L
        • Zhang G
        • Cui Y
        • Zhang L
        • Zhang Q
        • Fu T
        • Cao H
        • Li L
        • Gu Z
        Rate of adherence to urate-lowering therapy among patients with gout: a systematic review and meta-analysis.
        BMJ Open. 2018; 8e017542https://doi.org/10.1136/ bmjopen-2017-017542
        • Corbett EJM
        • Pentony P
        • McGill NW
        Achieving serum urate targets in gout: an audit in a gout-oriented rheumatology practice.
        Int J Rheum Dis. 2017; 20: 894-897
        • Sheer R
        • Null KD
        • Szymanski KA
        • Sudharshan L
        • Banovic J
        • Pasquale MK
        Predictors of reaching a serum uric acid goal in patients with gout and treated with febuxostat.
        Clinicoecon Outcomes Res. 2017; 9: 629-639
        • Rashid N
        • Coburn BW
        • Wu YL
        • Cheetham TC
        • Curtis JR
        • Saag KG
        • Mikuls TR
        Modifiable factors associated with allopurinol adherence and outcomes among patients with gout in an integrated healthcare system.
        J Rheumatol. 2015; 42: 504-512
        • De Vera MA
        • Marcotte G
        • Rai S
        • Galo JS
        • Bhole V
        Medication adherence in gout: a systematic review.
        Arthritis Care Res (Hoboken). 2014; 66: 1551-1559
        • Scheepers LEJM
        • van Onna M
        • Stehouwer CDA
        • Singh JA
        • Arts ICW
        • Boonen A
        Medication adherence among patients with gout: a systematic review and meta-analysis.
        Semin Arthritis Rheum. 2018; 47: 689-702
        • Tan C
        • Teng GG
        • Chong KJ
        • Cheung PP
        • Lim A
        • Wee HL
        • Santosa A
        Utility of the Morisky Medication Adherence Scale in gout: a prospective study.
        Patient Prefer Adherence. 2016; 10: 2449-2457
        • Singh JA
        • Hodges JS
        • Asch SM
        Opportunities for improving medication use and monitoring in gout.
        Ann Rheum Dis. 2009; 68: 1265-1270
        • Sheng F
        • Fang W
        • Zhang B
        • Sha Y
        • Zeng X
        Adherence to gout management recommendations of Chinese patients.
        Medicine. 2017; 96: 45
        • Jeyaruban A
        • Soden M
        • Larkins S
        General practitioners' perspectives on the management of gout: a qualitative study.
        Postgrad Med J. 2016; 92: 603-607
        • Abhishek A
        • Jenkins W
        • La-Crette J
        • Fernandes G
        • Doherty M
        Long-term persistence and adherence on urate-lowering treatment can be maintained in primary care-5-year follow-up of a proof-of-concept study.
        Rheumatology (Oxford). 2017; 56: 529-533