“The King of Diseases”

Gout is a rheumatic disease resulting from deposition of uric acid crystals (monosodium urate) in tissues and fluids within the body.

You may find it strange that I should invert the natural order of things and post about Treatment before Diagnosis. Well, if you’ve been following my series on Gout and found it interesting, I’ve more exciting things to say about diagnosis. I’m saving my best for last😉

And if you’re wondering why I should be calling the “Disease of Kings” the “King of Diseases”, I’m not the first. The answer in the next post.

Meanwhile, this is Gout as we know it.

Gout can cause diagnostic dilemmas that can impact patient treatment and care, as these case reports show.

Gout deserves the moniker, “The King Of Diseases” for at least 2 reasons:

1) It has been around for a long time and is almost synonymous with arthritis. Tell someone that you have arthritis, and there’s a good chance you’ll be receiving unsolicited advice on diet and beverages much akin to a low purine one. It is easily the most common inflammatory arthritides, and its prevalence is increasing in tandem with the rest of the Metabolic Syndrome;

2) It is the Great Pretender of our day, as this article seeks to show. It can mimic tumours and granulomas, infections and autoimmune diseases; depending on where it is deposited (and that’s everywhere), and the reaction it elicits. Conversely, some conditions can look like Gout, and even coexist with it, like Septic Arthritis and Psoriatic Arthritis.

Just yesterday, I reviewed a known Gout patient (for 20 years, untreated) with a swollen ankle which I aspirated and injected with steroid 3 days earlier, and covered empirically with antibiotics. The ankle joint was better, but the midfoot joint remained indurated. The aspirate culture returned as Group B Streptococcus (S. agalactiae)!