The overlying skin is tense, warm, shiny, and red or purplish. Fever, tachycardia, chills, malaise, and leukocytosis may occur. The first few attacks usually affect only a single joint and last only a few days, but later attacks may affect several joints simultaneously or sequentially and persist for weeks if untreated. Local symptoms and signs eventually regress, and normal joint function returns. Asymptomatic intervals vary but tend to become shorter as the disease progresses.
Urate deposits are common in the walls of bursae and tendon sheaths.
Enlarging tophi on the hands and feet may erupt and discharge chalky masses of urate crystals. Gout caused by cyclosporine often starts in the larger central joints, such as the hip and sacroiliac, as well as in the hands, and further damages renal tubules. Diagnosis Acute gouty arthritis has such distinctive clinical features that it can usually be tentatively diagnosed by history and physical examination. Demonstration in tissue or synovial fluid of needle-shaped urate crystals that are free in the fluid or engulfed by phagocytes is pathognomonic. The appearance of MSU crystals on compensated polarized light microscopy is described in Table 55-1.