Gouty arthritis
Gouty arthritis, the form of arthritis due to gout, is the name for a metabolic disease marked by uric acid deposits in the joints.
Gout is caused by a defect in metabolism which results in an overproduction of uric acid or leads to reduced ability of the kidney to eliminate uric acid. 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, as does lack of preventative measures in those with prior attacks.
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 often described as throbbing, crushing, or excruciating. The affected joints show signs of warmth, redness, and tenderness. The pain tends to subside within several days. Chronic gout attacks, however, occur more often.
If several attacks of gout occur each year this may cause chronic symptoms such as joint deformity and limitation of motion in affected joints. Uric acid deposits called tophi develop 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.
There may be a current or previous medical history of acute arthritis in one joint. A physical examination of joints shows arthritis and tophi.
Tests that indicate gouty arthritis include:
• Synovial fluid analysis that detects uric acid crystals Chronic gouty arthritis is treated with drugs like probenecid or sulfinpyrazone, which reduce uric acid levels. Another approach is to use allopurinol, which blocks 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 3 months), but it can also be continued at low doses to help prevent further attacks. Non-steroidal anti-inflammatory drugs are useful for acute attacks. One drug that can be used in hypertensive patients for the chronic treatment of gout is losartan (Cozaar). This is an anti-hypertensive drug that also lowers blood uric acid. Two drugs, febuxostat and PEG-uricase, are in clinical trial development and show promise.
Symptoms are generally worse in people who develop the disease before age 30.
Complications
• Kidney stones
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