Gouty arthritis

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.

Click here: Second Opinion Arthritis Treatment Kit

Gouty arthritis, the form of arthritis due to gout, is the name for a metabolic disease due to uric acid deposits in the joints.

The disorder causes inflammation, especially in the joints of the feet and legs. Patients with chronic gout may have repeated episodes of gouty arthritis.

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. 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 excessive intake of purine rich foods.

The condition may also develop in people who take drugs which interfere with uric acid excretion such as thiazide diuretics.

Symptoms of a gout attack come on suddenly, usually involving only one or a few joints. The pain frequently starts during the night and is often described as excruciatingly painful. The affected joints show signs of warmth, redness, and tenderness. The pain usually tends to subside within several days. Without treatment, attacks occur more often and become more intense.

If several attacks of gout occur, chronic joint deformity and limitation of motion in affected joints develops. Uric acid deposits called tophi form in cartilage tissue, tendons, and soft tissues. Deposits also can occur in the kidneys, leading to chronic renal failure.

Tests that indicate gouty arthritis include:

1.Synovial fluid analysis that detects uric acid crystals
2.Elevated serum uric acid level
3.Joint x-rays which show damage consistent with gouty arthritis

Chronic gouty arthritis is treated with drugs like probenecid or sulfinpyrazone, which increase uric acid excretion in the urine. Another approach is to use allopurinol or febuxostat (Uloric), which block the enzyme that produces uric acid, helping to reduce the level of uric acid. 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 continued at low doses to help prevent further attacks. It is usually discontinued after six months if the patient remians on uric acid lowering therapy.

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.

PEG-uricase (Krystexxa), is a drug that converts uric acid to inert allantoin, which is excreted by the kidneys. It is used in patients who have failed other gout drugs or who have tophaceous gout.

Gouty arthritis is generally worse in people who develop the disease before age 30.

Complications of gouty arthritis:

• Kidney stones
• Kidney failure
• Joint deformities
• Loss of mobility (patient becomes bedridden), rare

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