ICD-10: M1A.252

ICD-10 code M1A.252 specifically refers to drug-induced chronic gout affecting the left hip, characterized by the presence of tophus (tophi). This classification falls under the broader category of chronic gout, which is a type of inflammatory arthritis caused by the accumulation of uric acid crystals in the joints and surrounding tissues.

Clinical Description of Drug-Induced Chronic Gout

Definition and Etiology

Chronic gout is a recurrent condition that arises from prolonged hyperuricemia, where excess uric acid in the blood leads to the formation of monosodium urate crystals. These crystals can deposit in joints, tendons, and surrounding tissues, causing inflammation and pain. The designation "drug-induced" indicates that the condition is precipitated by certain medications that can elevate uric acid levels or interfere with its excretion. Common culprits include diuretics, certain chemotherapy agents, and medications used to treat hypertension[1][2].

Symptoms

Patients with drug-induced chronic gout may experience:
- Severe joint pain: Often sudden and intense, typically affecting the big toe but can also involve other joints, including the hip.
- Swelling and redness: The affected joint may appear swollen, warm, and red.
- Tophi formation: Over time, chronic gout can lead to the development of tophi, which are deposits of urate crystals that can form lumps under the skin, particularly around joints and in the ear[3][4].

Diagnosis

Diagnosis of drug-induced chronic gout involves:
- Clinical evaluation: Assessment of symptoms and medical history, including medication use.
- Joint aspiration: Analysis of synovial fluid from the affected joint can confirm the presence of urate crystals.
- Blood tests: Measurement of serum uric acid levels, although levels can be normal during acute attacks[5][6].

Treatment

Management of drug-induced chronic gout typically includes:
- Medication adjustment: Discontinuing or substituting the offending drug, if possible.
- Urate-lowering therapy: Medications such as allopurinol or febuxostat may be prescribed to reduce uric acid levels.
- Anti-inflammatory medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids can help alleviate pain and inflammation during acute attacks[7][8].

Prognosis

With appropriate management, including lifestyle modifications and medication adherence, patients can effectively control symptoms and reduce the frequency of gout attacks. However, ongoing monitoring is essential to prevent complications associated with chronic gout, such as joint damage and kidney stones[9].

Conclusion

ICD-10 code M1A.252 highlights the importance of recognizing drug-induced chronic gout, particularly in patients with a history of medication use that may elevate uric acid levels. Understanding the clinical presentation, diagnostic criteria, and treatment options is crucial for healthcare providers to manage this condition effectively and improve patient outcomes.

References

1. Chronic gout (M1A) - ICD List.
2. ICD-10-CM Diagnosis Code M1A - Chronic gout - ICD List.
3. ICD-10-CM Code for Drug-induced chronic gout, left hip M1A.252 - AAPC.
4. 2025 ICD-10-CM Codes M1A*: Chronic gout.
5. Rheumatology ICD 10 Codes.
6. ICD-10-CM 2010 Tabular Addenda.
7. Billing and Coding: Amniotic and Placental-Derived ...
8. ICD-10-CM Diagnosis Code M10: Gout.
9. ICD-10-CM code "M1A": Chronic gout (2024) | ICD Codes.

The ICD-10 code M1A.252 refers to "Drug-induced chronic gout, left hip." This condition is characterized by the presence of gout, a type of inflammatory arthritis, that is triggered by the use of certain medications. Below is a detailed overview of the clinical presentation, signs, symptoms, and patient characteristics associated with this diagnosis.

Clinical Presentation

Overview of Gout

Gout is a form of arthritis caused by the accumulation of uric acid crystals in the joints, leading to inflammation and pain. Chronic gout can develop when there are recurrent episodes of acute gout attacks, often resulting in joint damage over time. Drug-induced gout specifically refers to cases where medications contribute to elevated uric acid levels, precipitating gout attacks.

Drug-Induced Factors

Certain medications can lead to hyperuricemia (elevated uric acid levels), which may trigger gout. Common drug classes associated with drug-induced gout include:
- Diuretics: Often used for hypertension or edema, these can increase uric acid levels.
- Chemotherapy agents: Some cancer treatments can lead to rapid cell turnover, increasing uric acid production.
- Aspirin: Low-dose aspirin can inhibit uric acid excretion, contributing to elevated levels.

Signs and Symptoms

Common Symptoms of Chronic Gout

Patients with drug-induced chronic gout may experience a range of symptoms, including:

• Joint Pain: Severe pain in the left hip joint, which may be exacerbated by movement or weight-bearing activities.
• Swelling and Inflammation: The affected joint may appear swollen, red, and warm to the touch.
• Stiffness: Reduced range of motion in the left hip due to pain and inflammation.
• Tophi Formation: In chronic cases, patients may develop tophi, which are deposits of uric acid crystals that can form under the skin around joints.

Acute Gout Attacks

Patients may also experience acute gout attacks characterized by:
- Sudden onset of intense pain, often occurring at night.
- Symptoms may resolve within a few days to weeks, but chronic conditions can lead to persistent issues.

Patient Characteristics

Demographics

• Age: Gout is more common in middle-aged and older adults, particularly men over 40.
• Gender: Males are more frequently affected than females, although the risk for women increases post-menopause.
• Comorbidities: Patients may have other health conditions such as hypertension, diabetes, or kidney disease, which can complicate management.

Lifestyle Factors

• Diet: High purine diets (rich in red meat, seafood, and alcohol) can exacerbate gout symptoms.
• Medication History: A detailed medication history is crucial, as certain drugs may have precipitated the condition.

Family History

A family history of gout or related conditions may increase the likelihood of developing drug-induced chronic gout.

Conclusion

Drug-induced chronic gout, particularly affecting the left hip, presents with significant joint pain, swelling, and potential long-term joint damage if not managed appropriately. Understanding the clinical presentation, signs, symptoms, and patient characteristics is essential for effective diagnosis and treatment. Management typically involves addressing the underlying medication contributing to hyperuricemia, lifestyle modifications, and possibly pharmacological interventions to lower uric acid levels. Regular follow-up and monitoring are crucial to prevent recurrent attacks and manage chronic symptoms effectively.

ICD-10 code M1A.252 refers specifically to "Drug-induced chronic gout, left hip." Understanding alternative names and related terms for this condition can enhance clarity in medical documentation and communication. Below is a detailed overview of relevant terminology associated with this code.

Alternative Names for Drug-Induced Chronic Gout

1. Medication-Induced Gout: This term emphasizes that the gout condition is a result of specific medications, which can include diuretics or chemotherapy agents that elevate uric acid levels.

2. Chronic Gout Due to Drug Therapy: This phrase highlights the chronic nature of the gout and its direct link to drug therapy, making it clear that the condition is not idiopathic.

3. Pharmacological Gout: This term can be used to describe gout that arises as a side effect of pharmacological treatments.

4. Secondary Gout: While this term is broader, it can apply to gout that is secondary to other conditions, including drug use. It is important to specify that it is drug-induced.

Related Terms

1. Uric Acid Nephropathy: Although not directly synonymous, this term relates to the complications that can arise from chronic gout, particularly when uric acid levels are not managed effectively.

2. Hyperuricemia: This term refers to elevated uric acid levels in the blood, which is a precursor to gout. It is often a key factor in drug-induced cases.

3. Gouty Arthritis: This term describes the inflammatory arthritis that occurs during gout attacks, which can be triggered by drug-induced hyperuricemia.

4. Left Hip Gout: This specifies the affected joint, which is crucial for treatment and management discussions.

5. Chronic Gouty Arthritis: This term can be used to describe the long-term effects of chronic gout, particularly in the context of joint damage.

Conclusion

Understanding the alternative names and related terms for ICD-10 code M1A.252 is essential for accurate medical coding, effective communication among healthcare providers, and proper patient management. Utilizing these terms can help clarify the nature of the condition, its causes, and its implications for treatment. If you need further information or specific details about treatment options or management strategies for drug-induced chronic gout, feel free to ask!

To diagnose chronic gout, particularly drug-induced chronic gout affecting the left hip (ICD-10 code M1A.252), healthcare providers typically follow a set of established criteria. These criteria are based on clinical evaluation, laboratory tests, and imaging studies. Below is a detailed overview of the diagnostic criteria and considerations for this specific condition.

Clinical Criteria for Diagnosis

1. Patient History

• Medication Review: A thorough review of the patient's medication history is essential. Certain medications, such as diuretics, can precipitate gout attacks by increasing uric acid levels in the blood. Identifying any recent changes in medication or the introduction of new drugs is crucial[1].
• Symptoms: Patients often report symptoms such as joint pain, swelling, and redness, particularly in the affected area (in this case, the left hip). The pain is typically sudden and severe, often described as throbbing or excruciating[2].

2. Physical Examination

• Joint Examination: The healthcare provider will examine the left hip for signs of inflammation, including swelling, warmth, and tenderness. The range of motion may also be assessed to determine the impact of the condition on joint function[3].

3. Laboratory Tests

• Serum Uric Acid Levels: Elevated serum uric acid levels (hyperuricemia) are a hallmark of gout. While not definitive for diagnosis, levels above 6.8 mg/dL are suggestive of gout, especially when correlated with clinical symptoms[4].
• Synovial Fluid Analysis: If joint aspiration is performed, the synovial fluid can be analyzed for the presence of monosodium urate crystals, which confirm the diagnosis of gout. This is considered the gold standard for diagnosis[5].

4. Imaging Studies

• X-rays: Imaging may be used to assess joint damage or to rule out other conditions. X-rays can show characteristic changes associated with chronic gout, such as erosions or tophi in advanced cases[6].
• Ultrasound or MRI: These imaging modalities can help visualize urate crystal deposits and assess the extent of joint involvement, particularly in cases where the diagnosis is uncertain[7].

Differential Diagnosis

It is important to differentiate drug-induced chronic gout from other forms of arthritis, such as rheumatoid arthritis or osteoarthritis. This involves considering the patient's overall clinical picture, including the pattern of joint involvement and response to medications[8].

Conclusion

The diagnosis of drug-induced chronic gout affecting the left hip (ICD-10 code M1A.252) involves a comprehensive approach that includes patient history, physical examination, laboratory tests, and imaging studies. Identifying the specific medications that may have contributed to the condition is crucial for effective management and prevention of future gout attacks. If you suspect chronic gout, it is advisable to consult a healthcare professional for a thorough evaluation and appropriate treatment plan.

Chronic gout, particularly when induced by medications, can be a challenging condition to manage. The ICD-10 code M1A.252 specifically refers to drug-induced chronic gout affecting the left hip. Understanding the standard treatment approaches for this condition involves a multi-faceted strategy that includes lifestyle modifications, pharmacological interventions, and patient education.

Understanding Drug-Induced Chronic Gout

Chronic gout is characterized by recurrent episodes of arthritis due to the deposition of monosodium urate crystals in the joints, often resulting from elevated serum uric acid levels. Drug-induced gout can occur due to medications that either increase uric acid production or decrease its excretion. Common culprits include diuretics, certain chemotherapy agents, and medications like aspirin at low doses[1].

Standard Treatment Approaches

1. Pharmacological Management

Urate-Lowering Therapy (ULT)

The cornerstone of chronic gout management is urate-lowering therapy, which aims to reduce serum uric acid levels to below 6 mg/dL. Common medications include:

• Allopurinol: A xanthine oxidase inhibitor that reduces uric acid production. It is often the first-line treatment for chronic gout[2].
• Febuxostat: Another xanthine oxidase inhibitor, effective for patients who cannot tolerate allopurinol[3].
• Probenecid: This medication increases uric acid excretion through the kidneys and may be used in patients with under-excretion of uric acid[4].

Anti-Inflammatory Medications

During acute gout flares, anti-inflammatory medications are crucial for pain management:

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Such as ibuprofen or naproxen, are commonly used to alleviate pain and inflammation during acute attacks[5].
• Colchicine: Effective in reducing inflammation during acute gout attacks, especially if administered early in the flare[6].
• Corticosteroids: These may be prescribed for patients who cannot tolerate NSAIDs or colchicine[7].

2. Lifestyle Modifications

Lifestyle changes play a significant role in managing chronic gout:

• Dietary Adjustments: Patients are advised to limit purine-rich foods (e.g., red meat, shellfish) and avoid high-fructose corn syrup. Increasing the intake of low-fat dairy products and vegetables can be beneficial[8].
• Hydration: Adequate fluid intake helps dilute uric acid levels and promotes its excretion[9].
• Weight Management: Achieving and maintaining a healthy weight can significantly reduce the frequency of gout attacks[10].

3. Patient Education and Monitoring

Educating patients about their condition is vital for effective management:

• Understanding Triggers: Patients should be informed about medications that may exacerbate gout and encouraged to discuss any changes in their medication regimen with their healthcare provider[11].
• Regular Monitoring: Regular follow-up appointments to monitor uric acid levels and adjust treatment as necessary are essential for long-term management[12].

Conclusion

Managing drug-induced chronic gout, particularly in the left hip, requires a comprehensive approach that combines pharmacological treatment, lifestyle modifications, and patient education. By effectively lowering uric acid levels and addressing lifestyle factors, patients can significantly reduce the frequency and severity of gout attacks. Regular monitoring and open communication with healthcare providers are crucial for optimizing treatment outcomes and improving the quality of life for individuals affected by this condition.

For personalized treatment plans, it is always recommended to consult with a healthcare professional who can tailor the approach based on individual patient needs and medical history.