Snapshot A 55-year-old woman presents to the emergency department with acute pain in the left proximal interphalangeal (PIP) joint of the second digit. She reports that the pain is excruciating and has happened once a few years ago but self-resolved over the course of 2 weeks. She states that she recently increased her alcohol and red meat consumption and was recently started on hydrochlorothiazide. On physical exam the PIP joint is swollen, erythematous, warm, and tender to palpation. Preparations are made for an arthrocentesis to be performed. Introduction Clinical definition login to view 1 more bullet Epidemiology Demographics login to view 1 more bullet Risk factors login to view 1 more bullet Etiology Hyperuricemia login to view 18 more bullets Pathogenesis login to view 8 more bullets Presentation Symptoms login to view 5 more bullets Physical exam login to view 13 more bullets Studies Labs login to view 3 more bullets Synovial fluid analysis login to view 3 more bullets Differential Septic arthritis login to view 6 more bullets Pseudogout login to view 4 more bullets DIAGNOSIS Making the diagnosis login to view 2 more bullets Treatment Management approach login to view 4 more bullets Conservative login to view 7 more bullets Medical login to view 25 more bullets Prognosis Acute attacks typically self-resolve Patients have an increased risk of recurrence Advanced gout and tophi may result without proper treatment