Gouty Arthritis
Gout is a very painful condition that develops in some people who have chronically high blood levels of uric acid, which is produced in the liver, and insufficiently eliminated through the kidney. Crystals of uric acid may precipitate in the joints and produce the gouty arthritis. Uric acid crystals can also be deposited in the kidney or urinary tract, and cause kidney stones and occasionally impairing kidney function. More than 15 % of patients with gout develop also kidney stones. It is estimated that gout affects approximately 2% of people in the United States.
Risk factors for gout:
- Young men between 20 and 45 years old and postmenopausal women.
- Obesity and high blood pressure.
- Injury or recent surgery, dehydration or fasting may precipitate a gouty attack.
- Excessive consumption of alcoholic beverages (beer, whiskey, gin, vodka, and rum) and overeating, especially large amounts of meat and seafood.
- Medications that affect blood levels of uric acid like diuretics, low dose aspirin, levodopa and anti-seizure medications.
Signs and symptoms
Acute gouty arthritis: the attacks of gout usually involve a single painful, red, warm, swollen joint, most often with fluid collection in the big toe, ankle or knee. Patients with osteoarthritis in the fingers may experience their first gout attacks in the fingers (in the Heberden’s or Bouchard’s nodes) rather than the toes or knees. If gout is untreated the attacks recur more frequently; time between attacks may shorten and attacks may become increasingly severe and prolonged, involving multiple joints at once and may be accompanied by fever. Chronic attacks can be destructive causing resorption and erosion of the bone, and can potentially cause joint deformities. Chronic tophaceous gout is induced by repeated attacks of gout over many years leading to tophies formation. Tophies consist of large deposits of uric acid crystals collected around joints, bursa and tendons and appear as nodules and soft mass possible with fluid collection.
Treatment
Acute attack is treated with daily colchicine and steroids at a low dose. If joint fluid is present, tapping the joint to withdraw fluid, and intra-articular long acting steroid injection are recommended. As soon as the acute attack subsides, the steroids should be tapered, colchicine treatment should continue while adding uric acid lowering agents like Allopurinol and Probenecid. Blood work every 3 months is required including the level of uric acid. The medications should be tapered or stopped only under medical supervision. Changes in diet may modestly reduce the frequency of gouty attacks in some patients. Losing weight is an important goal. NSAIDs are modestly effective in the treatment of the acute or chronic gouty attacks and the benefits of using this medication are controversial.