Gout is a recurrent acute arthritis of peripheral joints that results from deposits in and about the joints and tendons, of crystals of monosodium urate that develop from supersaturated hyperuricemic body fluids. The condition may become chronic and deforming.

For primary gout, the exact cause is unknown; however, it seems to tend to occur in families. Secondary gout develops in relation to another disease including: obesity; diabetes mellitus; high blood pressure; polycythemia; leukemia; myeloma; sickle cell anemia; and renal disease. Gout can also develop secondary to drug therapy, especially from some diuretics.

The onset of the condition is acute, usually occurring at night and involving one articular. The first metatarsophalangeal joint of the great toe is most commonly involved. Other joints that may be involved include those of the feet, ankles, and knees. Other signs and symptoms related to the affected joint include: extreme pain; heat; swelling; tenderness; and dusky-red color or cyanosis. Long-term accumulation of uric acid may produce lumps, called tophi, just beneath the skin. In addition, fever, hypertension, and nephrolithiasis may be presented. Shedding of the skin and pruritus may develop after the inflammatory process subsides. Hyperuricemia and urate crystals are usually found in the joint fluid or tophi. If the condition is chronic, urate deposits are found in subcutaneous tissue, bone, cartilage, joints, and other tissue.

Diagnostic measures include: arthrocentesis to obtain synovial fluid to check for presence of monosodium urate crystals; urinalysis (to check for elevated uric acid levels); and tests of serum and blood (to determine the presence of elevated uric acid levels).

Treatment measures include: bed rest; immobilization and protection of affected joints; application of heat or cold; and administration of analgesics. For severe cases, drug therapy with anti-gout medicine, corticosteroids or corticotropin may be utilized. Joint aspiration is also used to decrease serum and blood uric acid levels. Analgesics may be given for pain, and bed rest, needed during the acute attacks, is continued for at least 24 hours. Possible dietary restrictions may be needed including: avoidance of alcohol and purine-rich foods such as, meat, fish, sweetbreads, and spinach. In cases of joint deformity, surgery to improve function and correct deformities may be necessary.

The residuals of the condition include progressive functional loss and disability if the condition becomes chronic. Residuals may also include possible joint deformity, persistent pain, arthritis, and tophi formation in joints. The interval between attacks varies up to years. A limited number of individuals are bedridden from the deformities.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• The provisions for 10 and 20 percent evaluations for arthritis with multiple joint involvement without limitation of motion do not apply to these conditions as is reflected in Note (2) under DC 5003.

• May be entitled to special monthly compensation where the veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

• Evaluate the diseases under diagnostic codes 5013 through 5024 as degenerative arthritis, based on limitation of motion of affected parts.