With its intensity the chills and shivers increase. After a time this comes to a full height, accommodating itself to the bones and ligaments of the tarsus and metatarsus. So exquisite and lively meanwhile is the feeling of the part affected, that it cannot bear the weight of bedclothes nor the jar of a person walking in the room. Acute attack of gout at the ankle and 1 st MTP joints. An attempt should be made to document gout in the affected joint by aspiration and examination for crystals, particularly in a large joint that is easily accessible.
Infection needs to be ruled out in an acute monoarthritis.
Intracellular crystals within a neutrophil are characteristic during the acute attack. Fluid should be sent to the lab in a green top and purple top tubes to facilitate the joint count and crystal exam. Crystals may be present in the joint several days after the acute attack of gout resolves. After years of gouty attacks, patients will develop a chronic arthritis resulting in bone and cartilage destruction and deformity. Uric acid crystals deposit within and surrounding the joint causing a chronic destructive inflammatory process.