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Causes * uric acid production (high purine diet, alcohol) * renal excretion (renal disease, diuretics) * Gout Classic Joint * 1st metatarsophalangeal joint (big toe) Podagra Clinical Features * Sudden, severe joint pain (often at night ) * Red, hot, swollen joint * Extremely tender (cant tolerate bed sheet touch) * Recurrent attacks Diagnosis * Joint aspiration: * Needle-shaped crystals * Negative birefringence (under polarized light) Treatment Acute attack * NSAIDs (e.g

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