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Gout
Gout is a type of arthritis that is caused by monosodium
urate crystals deposited in the soft tissue of the body. Gout is very common, particularly in
men. People that are overweight, have
kidney dysfunction, or drink alcohol or more at risk. It occurs in about 1 of 500 individuals.
Clinical
Presentation (see pictures)
- Elevated
uric acid serum levels. (great than 6.5 mg/dL)
- Severe
pain (it hurts to put the sheets over my foot at night)
- Red
hot swollen joints the big toe joint is commonly affected 50% of the time
- Other
joints may be the ankle, midfoot, heel, or knee
- Gouty
attacks may reoccur at multiple times and multiple joints
- Patient
may have high fever and chills
Etiology of gouty attacks
- Alcohol
binges
- Surgery
- Trauma
- Diuretics
- Uric
acid lowering agents
Diagnosis
- Increased
WBC
- Increased
Serum uric acid levels but not always
- Must
aspirate the joint to find crystals (Polarized micrograph of urate crystal
shows negative birefringent pattern with long, needle-shaped crystals)
- X-rays
findings show punched-out lesions with a sclerotic margin
Treatment
- Acute
attacks
- NSAIDS
- Colchicine
.6 mg every hour until side effects intervene or attack stops
- Corticosteroids
(Prednisone)
- Uric
Acid-Lowering therapy
- Decrease
obesity
- Decrease
alcohol abuse
- Decrease
medication that elevate uric acid level
- Medications
to decrease uric acid in blood (these meds work by increasing the kidneys
to get rid of the uric acid)
- Probenecid
250mg twice a day (max: 3000mg 2 or 3 times a day)
- Sulfinpyrazone
50mg twice a day (max: 600mg 2 or 3 times a day)
- Medications
to decrease uric acid in the blood by interfering directly with uric acid
production
- Allopurinol
300mg per day, but may start it at 100mg per day
disclaimer
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