= Solution
\b[<Gout> is a crystal-deposition disorder; “<rheumatism>” was a broader historical label that must be separated into acute rheumatic fever and several chronic joint disorders.] In particular, chronic rheumatism is not a precise synonym for modern <rheumatoid arthritis>.
In \b[acute <gout>], a sudden, intensely painful, red, hot and swollen <anatomical joint> is characteristic. The first metatarsophalangeal <anatomical joint> is a classic site, and early attacks often affect one <anatomical joint> with intervals of recovery. The material responsible is <monosodium urate> deposited in or around the <anatomical joint>, with an acute inflammatory reaction. High <serum urate> supports the diagnosis but neither guarantees clinical <gout> nor excludes it when a sample during a flare is ordinary.<Gout by Merck Manual Professional Edition>[Introduction; crystal deposition; Diagnosis, serum urate]{ref}
In \b[chronic <gout>], persistent deposits can form <tophi>, including periarticular nodules and deposits in the ear or other cooler sites. Surrounding inflammatory <tissue> and <fibrosis> accompany the deposits; recurrent damage can erode articular structures and cause deformity and persistent symptoms. More than one <anatomical joint> may then be affected. The chalk-like material is a deposit of urate, not new <bone>, and not merely an accumulation of ordinary <pus>.<Gout by Merck Manual Professional Edition>[Pathophysiology; chronic tophaceous gout]{ref}
The classical \b[acute rheumatism] of this comparison is usually <acute rheumatic fever>. In its typical articular presentation, <fever> accompanies painful inflammation that migrates between large <anatomical joints>, rather than repeatedly selecting one small distal site. In modern terms it is a delayed immune-mediated sequel of <Group A streptococcal infection>. <Carditis>, especially involvement of cardiac <cardiac valves>, is a major distinguishing concern; chorea and characteristic skin manifestations may also occur. The articular illness usually subsides without the progressive urate deposits of chronic <gout>. The later understanding of the streptococcal cause must be distinguished from nineteenth-century constitutional theories.<Clinical Guidance for Acute Rheumatic Fever by CDC>[Cause; Clinical features, migratory arthritis and carditis]{ref}
For \b[chronic rheumatism], distinguish at least two important modern patterns. <Rheumatoid arthritis> causes persistent inflammatory <synovitis>, commonly affecting corresponding small <anatomical joints> on both sides. Thickened inflamed <synovium> and invasive <pannus> can damage <cartilage> and <bone>, producing lasting deformity. <Osteoarthritis>, also historically included among chronic or deforming rheumatic complaints, instead emphasizes loss of articular <cartilage>, altered underlying <bone> and <osteophytes>. These conditions cannot be identified merely by saying that the <anatomical joints> have been painful for a long time.<Rheumatoid Arthritis by Merck Manual Professional Edition>[Pathophysiology; Symptoms and Signs; Differential diagnosis]{ref}<Osteoarthritis by Merck Manual Professional Edition>[Pathophysiology and structural changes]{ref}
A modern discriminating examination for suspected <gout> examines aspirated <synovial fluid> with a <polarizing microscope>. Needle-like, strongly negatively birefringent <monosodium urate> crystals support the diagnosis; a suitable compensator helps assess their optical behaviour.<Gouty Tophus by Weill Cornell Medicine>[Crystal morphology, polarized examination and preservation in alcohol]{ref} This is later diagnostic technique, not a test claimed to have been supplied in 1866. <Microbiological culture> addresses a different alternative, <septic arthritis>; crystals and infection can coexist. Clinical distribution and duration remain useful, but neither appearance nor a single <serum urate> value settles every case.<Gout: diagnosis and management by NICE>[NG219, recommendations 1.1.3–1.1.9, differential diagnosis, serum urate and aspiration]{ref}
\b[Acute versus chronic describes the course; gout versus a particular rheumatic disease identifies a mechanism.] The two distinctions must be made separately.
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