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THROUGH THE LENS
Year : 2014  |  Volume : 5  |  Issue : 6  |  Page : 134-135  

Podagra


1 Consultant Dermatologist, Microcare Hospital, Sion, Mumbai, Maharashtra, India
2 Department of Dermatology, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India

Date of Web Publication5-Dec-2014

Correspondence Address:
Dr. Ganesh Avhad
6/181, Veena Apt. Tribhuvan Co op Society, Sion East, Mumbai - 400 022, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5178.146196

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How to cite this article:
Avhad G, Ghuge P. Podagra. Indian Dermatol Online J 2014;5, Suppl S2:134-5

How to cite this URL:
Avhad G, Ghuge P. Podagra. Indian Dermatol Online J [serial online] 2014 [cited 2019 Oct 22];5, Suppl S2:134-5. Available from: http://www.idoj.in/text.asp?2014/5/6/134/146196

A 43-year-old male presented with painful swelling over the right great toe since one week [Figure 1]. It started as a small, asymptomatic swelling one month ago that gradually increased in size and became painful. No similar lesion was present elsewhere on the body. He denied history of any drug intake prior, morning stiffness or major joint pain, major illness, or family history of similar complaints.
Figure 1: Firm, yellowish tender nodule measuring 3 3 cm over right great toe

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Cutaneous examination showed firm, skin coloured to yellowish, tender nodule 3 × 3 cm in size over the right great toe. Similar small nodule was present on the adjacent toe. Hematological examination showed increased serum uric acid levels (11.7 mg/dL), while other investigations including liver and renal function tests, serum electrolytes, total blood count, and coagulation profile were all within normal limits. Fine needle aspiration cytology showed multiple needle-shaped crystals with negative birefringence under polarized microscope [Figure 2]. Histopathology showed an amorphous material formed by aggregates of urate crystals in the upper and mid dermis with a surrounding inflammatory infiltrate, confirming our diagnosis [Figure 3].
Figure 2: Polarized microscopy showing characteristic needle-shaped negative birefringence urate crystals

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Figure 3: Multiple deposits of an amorphous material formed by aggregates of urate crystals in the upper and mid dermis (H and E, 40)

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The name "gout" is derived from the Latin word "gutta" means "drop". Ancient Greeks first noticed the predilection for the deposition of the crystals at the base of great toe and they referred it as podagra which means "foot-grabber". They thought that podagra occurs as a result of the bodily humors falling to the affected body part as suggested by humoral theory of Hippocrates. [1]

Gout is a metabolic disease of purine metabolism in which crystals of monosodium urate are deposited in various tissues and joints initiating an inflammatory process and subsequent destruction. Monoarticular joint involvement is most common especially involving the base of the great toe, the metatarsophalangeal joint (50%). This joint is involved because of local anatomical characteristic of lower temperature and repetitive physical trauma, which makes it an ideal site for crystal deposition. An attack of gouty arthritis starts abruptly and reaches peak intensity within a few hours. [1]

The differential diagnoses would be rheumatoid arthritis, pseudogout, and calcinosis cutis. Treatment is multipronged in the form of relieving the inflammatorty pain of acute attacks, the lowering uric acid levels, and prevention of urate crystal deposition. [2]

 
   References Top

1.
Roddy E. Revisiting the pathogenesis of podagra: Why does gout target the foot? J Foot Ankle Res 2011;4:13.  Back to cited text no. 1
[PUBMED]    
2.
Keith MP, Gilliland WR. Updates in the management of gout. Am J Med 2007;120:221-4.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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