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Gouty arthritis

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)
    gouty arthritis

    Gouty arthritis in the hands

  • 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
  • May cause GI problems
  • 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