Gouty arthritis treatment
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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The term “gouty arthritis” is used to describe the arthritis that accompanies gout. Gout is a metabolic problem due to an excessive accumulation of uric acid. Either the body can’t get rid of uric acid quickly enough or the body is over-producing uric acid.
Uric acid is a by-product of the metabolism of purines, a building block of many foods. Inability of the body to get rid of uric acid leads to accumulation of uric acid in different organ systems, the most prominent being the joints and the kidneys.
The disorder causes severe pain, especially in the joints of the feet and legs. Patients with chronic gout may have repeated episodes of gouty arthritis.
The arthritis is caused an acute inflammatory attack caused by uric acid crystals. White blood cells, which are attracted to the area of inflammation, ingest the crystals. As crystals are engulfed by white cells, they cause the release of multiple enzymes that perpetuate and aggravate inflammation.
The exact cause is unknown. Risk is increased in males, postmenopausal women, and people with hypertension. Heavy alcohol use, diabetes, obesity, sickle cell anemia, and kidney disease also increase risk. Dietary intake of purine rich foods is another trigger.
The condition may also develop in people who take drugs which interfere with uric acid excretion.
An attack of chronic gout is similar to an attack of acute gouty arthritis. Symptoms come on suddenly, usually involving only one or a few joints. The pain frequently starts during the night and is excruciating. The affected joints show signs of warmth, redness, and tenderness. The pain tends to subside within several days. Chronic gout attacks become more frequent.
Chronic symptoms such as joint deformity and limitation of motion in affected joints can develop. Uric acid deposits called tophi form in cartilage tissue, tendons, and soft tissues. These tophi usually develop only after a patient has suffered from the disease for many years. Deposits also can occur in the kidneys, leading to chronic renal failure.
Tests that indicate gouty arthritis include:
•Synovial fluid analysis that detects uric acid crystals
•Elevated blood uric acid level
•Joint x-rays which show damage consistent with gouty arthritis
Chronic gouty arthritis is treated with drugs like probenecid or sulfinpyrazone, which increase urinary output of uric acid. Another approach is to use allopurinol or febuxostat (Uloric), which block the enzyme that produces uric acid, helping to reduce the level of this chemical. Patients should drink plenty of water or other fluids to decrease the risk of kidney complications.
Colchicine can be added to prevent further acute attacks. This drug can be discontinued when uric acid levels are stable (usually after 6 months) to help prevent further attacks.
Non-steroidal anti-inflammatory drugs also are used.
One interesting drug that can be used in gout patients with hypertension is losartan (Cozaar). Cozaar is used to treat hypertension but has the added effect of lowering uric acid.
PEG-uricase (Krystexxa) is a drug administered intravenously that converts uric acid to allantoin, an inert ingredient that is excreted in the urine. This is used for patients who don;t respond to other drugs or who have tophaceous gout.
Gout may occur in association with other types of arthritis such as pseudogout- a condition due to calcium pyrophosphate crystals- and psoriatic arthritis- the arthritis associated with psoriasis. It is rarely associated with rheumatoid arthritis.
Symptoms are generally worse in people who develop the disease before age 30.
It is important to treat co-morbid conditions. Patients with gout are likely to have hypertension, renal insufficiency, elevated lipids, obesity, and diabetes. Excessive alcohol intake also needs to be addressed.
Complications of gout:
• Kidney stones
• Kidney failure
• Joint deformities
• Loss of mobility
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