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Year : 2010  |  Volume : 53  |  Issue : 4  |  Page : 826
Monoarticular gout: Cytological diagnosis

Department of Pathology, Maulana Azad Medical College, New Delhi, India

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Date of Web Publication27-Oct-2010

How to cite this article:
Kawatra V, Agarwal S, Kohli K, Jain S. Monoarticular gout: Cytological diagnosis. Indian J Pathol Microbiol 2010;53:826

How to cite this URL:
Kawatra V, Agarwal S, Kohli K, Jain S. Monoarticular gout: Cytological diagnosis. Indian J Pathol Microbiol [serial online] 2010 [cited 2021 Aug 3];53:826. Available from: https://www.ijpmonline.org/text.asp?2010/53/4/826/72059

We present case of a 35--year--old thin--built, nonalcoholic, nondiabetic male with complaints of a nodule over the right elbow of 2 months duration [Figure 1]a. He was otherwise asymptomatic and there was no history of trauma or any other significant history.
Figure 1: (a-b) Solitary nodule present over right elbow joint, Cytology smears show presence of needle-shaped crystals in a proteinaceous background (Giemsa, ×100), (c-d) Negatively birefringent crystals under polarized microscope (c ×60, d ×100)

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On examination, a firm skin--colored nodule measuring 1 cm in diameter was noticed over the right elbow. Plain radiograph showed a soft tissue swelling. Fine needle aspiration cytology was performed and smears were stained with Giemsa. Smears showed many scattered needle-shaped crystals in a proteinaceous background [Figure 1]b. Under polarized microscope, these crystals were negatively birefringent [Figure 1]c,d. A diagnosis of monoarticular gout of elbow joint was made. Serum urate levels in the present case were within normal limits.

Hyperuricemia is the main factor that facilitates the formation of monosodium urate (MSU) crystals, although other factors (such as local temperature and trauma) may also play a role. An increased serum urate level of approximately 6.8 mg/dl is the concentration at which MSU crystals begin to precipitate. [1]

Noteworthy finding is that serum urate level may be normal at the time of acute presentation of gout, but may get elevated 2 weeks later. Elevated levels of serum urate during the intercritical periods are predictive of future gout attacks. [2]

Numerous risk factors such as excess alcohol intake, purine-rich diets (meat, fish, and seafood), high carbohydrate diet, and obesity have been implicated in the development of hyperuricemia and gout. It is worth mentioning here that certain dietary factors like vitamin C, coffee, and dairy products might play a protective role against development of gout. [3]

Typically these patients present with intense joint pain at night when the extremities are colder; however, they may also remain asymptomatic for long period of time, like our present case. [4] The presence of urate crystals in synovial fluid is the gold standard for diagnosing gout, and aspiration cytology has a definitive role in the diagnosis.

   References Top

1.Loeb JN. The influence of temperature on the solubility of monosodium urate. Arthritis Rheum 1972;15:189-92.   Back to cited text no. 1
2.Urano W, Yamanaka H, Tsutani H, Nakajima H, Matsuda Y, Taniguchi A, et al. The inflammatory process in the mechanism of decreased serum uric acid concentrations during acute gouty arthritis. J Rheumatol 2002;29:1950-3.  Back to cited text no. 2
3.Roddy E. Hyperuricemia, gout, and lifestyle factors. J Rheumatol 2008;35:1689-91.  Back to cited text no. 3
4.Kharkar V, Kembre P, Mahajan S, Khopkar U. Multiple asymptomatic nodules in a middle-aged patient. Tophaceous gout. Indian J Dermatol Venereol Leprol 2007;73:369-70.  Back to cited text no. 4
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Correspondence Address:
Vibha Kawatra
11/137 Malviya Nagar, New Delhi - 110017
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0377-4929.72059

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