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Acute gouty arthritis (gout) Causes and Risks:
Gout is caused by a defect in metabolism that results in an overproduction of uric acid , or a reduced ability of the kidney to eliminate uric acid. The exact cause of the metabolic defect is unknown. The condition may also develop in people with diabetes mellitus , obesity , sickle cell anemia , and kidney disease , or it may follow drug therapy that interferes with uric acid excretion.
Gout has four stages: asymptomatic (without symptoms), acute ,
intercritical, and chronic . In acute gouty arthritis, symptoms develop suddenly and usually involve only one or a few joints. The pain frequently starts during the night and is often described as throbbing , crushing, or excruciating. The joint appears infected with signs of warmth, redness, and tenderness. The attacks of painful joints may subside in several days, but may recur at irregular intervals. Subsequent attacks usually have a longer duration. Some people may progress to chronic gouty arthritis , while others may have no further attacks.
Risk is increased in males, postmenopausal women, and people with kidney disease, diabetes mellitus, sickle cell anemia, or obesity. The incidence is 5 out of 1000 people.
Prevention:
The disorder itself may not be preventable, although some precipitating factors may include trauma, alcohol consumption , and dietary
purines. Medications may reduce attacks in a person with gout.
Symptoms:
- joint pain
- begins suddenly
- in one or more joints ( hip pain , knee pain , ankle pain , foot pain , shoulder pain , elbow pain , wrist pain , hand pain, or pain in other joints)
- the great toe, knee, or ankle joint are most often affected
- joint swelling of any of the above joints
- stiffness of the joint
- the joint may be warm and red
- fever may be present
- skin lump over a joint, may have chalky material draining out of the lump
- finger pad abnormalities
Signs and Tests:
Physical examination of the joints shows acute arthritis .
This disease may also alter the results of the following tests:
Treatment:
The objectives of treatment are mainly to stop the pain and inflammation associated with the initial attack, and to prevent future attacks.
Medications:
Colchicine is one of the anti-inflammatory medications that is effective in reducing the pain, swelling , and inflammation associated with acute gout attacks. The pain usually subsides within 12 hours of starting treatment and is completely relieved in 48 hours. The medication works by decreasing the inflammation caused by uric acid crystals within the joint. However, it does not decrease the uric acid levels in the bloodstream. Daily use of colchicine or allopurinol helps prevent future attacks.
Codeine or other analgesics may occasionally be prescribed for pain relief.
Increased fluid intake prevents the formation of kidney stones .
Sometimes a diet low in purines is prescribed. Organ meats, beer, wine, and certain types of fish contain high levels of purines.
Prognosis:
Treatment of acute attacks allows people to live a normal life. The acute form of the disease may progress to chronic disease. Symptoms are generally worse in people who develop the disease before age 30. Also, since uric acid is normally eliminated by the kidneys, chronic gout may lead to formation of uric acid kidney stones ( renal calculi ).
Complications:
Call Your Healthcare Provider:
Call for an appointment with your health care provider if symptoms occur that are suggestive of acute gouty arthritis.
Picture:
P0673.pctUric acid crystals
These spiked rods are uric acid crystals photographed under polarized light. Increased uric acid blood levels and formation of uric acid crystals in the joints are associated with gout.
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