Arthritis of the first metatarsophalangeal joint is not always gout

NewsBot · Jan 29, 2014

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Arthritis of the first metatarsophalangeal joint is not always gout: A prospective cohort study in primary care patients.
Kienhorst LB, Janssens HJ, Fransen J, van de Lisdonk EH, Janssen M.
Joint Bone Spine. 2014 Jan 24.

OBJECTIVES:
Arthritis of the first metatarsophalangeal joint has been considered pathognomonic for gout, but it is unknown how frequently other forms of arthritis occur in this joint. The aims were to determine the validity of the general practitioner's clinical diagnosis using joint fluid analysis as the reference test, the prevalence of other diagnoses than gout, and the signs and symptoms that discriminate between gout and non-gout patients.
METHODS:
This prospective cohort study comprised primary care patients with monoarthritis of the first metatarsophalangeal joint. After patient recruitment by general practitioners, patients' characteristics were collected by a rheumatologist. Joint fluid was analyzed for the presence of monosodium urate-crystals. If crystals were absent, patients entered a follow-up period of 6years, or until a definite diagnosis. If during follow-up crystals were identified, the patient was classified as already having gout at baseline assessment.
RESULTS:
One hundred and fifty-nine primary care patients were included. At baseline the clinical diagnosis was gout in 98%. The positive and negative predictive values of the diagnosis of gout were 0.79 and 0.75, respectively. After follow-up 77% had gout, 8% had another rheumatic disease, and 15% had a transient unspecified monoarthritis. Gout patients had discriminating signs and symptoms from non-gout patients.
CONCLUSIONS:
Gout is an important but certainly not an exclusive cause of arthritis of the first metatarsophalangeal joint.
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Admin2 · Jan 29, 2014

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NewsBot · May 2, 2023

Assessment and Management of Atraumatic First Metatarsophalangeal Joint Pain
Sebastián Drago, Hannah Nazaroff, Joshua Britton, Andrea Veljkovic
J Am Acad Orthop Surg. 2023 Apr 28

Nontraumatic pain in the first metatarsophalangeal joint is frequent and can be debilitating. The metatarsophalangeal joint complex comprises four articulating surfaces including the first metatarsal, the proximal phalanx, and tibial and fibular sesamoids, which are all contained within a synovial capsule. The most common causes of pain are hallux valgus and hallux rigidus. However, other diagnoses, such as functional hallux limitus, sesamoiditis, gout, and inflammatory autoimmune arthritis, need to be considered as well. A systematic approach is key to accurately diagnose the source of pain, which can sometimes be the result of more than one condition. The most important clinical information to obtain is a focused history, meticulous clinical examination based on understanding the precise anatomy and biomechanics of the first metatarsophalangeal joint, and analysis of the relevant imaging. Each pathology has a different treatment algorithm, as such, understanding the pathoanatomy and biomechanics is important in forming an effective treatment plan.
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