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Acute Gouty Arthritis
Definition
Acute gouty arthritis is a sudden attack of pain in the joints, especially in the feet and legs, that occur when uric acid builds up in the joints.
Alternative Names
Gouty arthritis - acute; Gout - acute
Causes
Gout is caused by an overproduction of uric acid or a reduced ability of the kidney to get rid of uric acid. The exact cause is unknown. It is more common in males, postmenopausal women,
and people who drink alcohol.
The condition may also develop in people with:
• Diabetes
• Kidney disease
• Obesity
• Sickle cell anemia
The condition may occur after taking medicines that interfere with uric acid excretion.
Gout has 4 stages:
• Asymptomatic
• Acute
• Intercritical
• Chronic
This article discusses acute gouty arthritis only.
Symptoms
Symptoms develop suddenly and usually involve only one or a few joints. The big toe, knee, or ankle joints are most often affected.
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 go away in several days, but may return from time to time. Additional attacks usually last long. Some people may progress to chronic gouty arthritis, while others may have no further attacks.
Specific symptoms include:
• Fever (sometimes)
• Joint pain
• Joint swelling of the affected joints
• Join stiffness
• Joint redness
• Skin lump which may drain chalky material
Exams and Tests
Tests that may be done include:
• Blood differential
• Joint x-rays (may be normal)
• Synovial biopsy
• Synovial fluid analysis (shows uric acid crystals)
• Uric acid- blood
• Uric acid - urine
Treatment
A prescription medicine called colchicine helps reduce pain, swelling, and inflammation associated with acute gout attacks. The medication decreases the inflammation caused by uric acid
crystals within the joint. It does not decrease the uric acid levels in the bloodstream.
The pain often goes away within 12 hours of starting treatment, and is completely relieved in 48 hours. Daily use of colchicine or allopurinol helps prevent future attacks.
Your doctor may also recommend that you take non-steroidal anti-inflammatory drugs (NSAIDs) as soon as symptoms start to relieve pain and inflammation. Strong painkillers such as codeine may occasionally be prescribed.
Corticosteroids can also be very effective. Your doctor may inject the inflamed joint with steroids to relieve the pain.
Drinking more fluids helps 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.
Outlook (Prognosis)
Proper treatment of acute attacks allows people to live a normal life. However, the acute form of the disease may progress to chronic gout.
Possible Complications
• Side effects of medications
• Chronic gouty arthritis
• Kidney stones
• Kidney dysfunction
When to Contact a Medical Professional
Call for an appointment with your health care provider if you have symptoms of acute gouty arthritis.
Prevention
The disorder itself may not be preventable, but you may be avoid to avoid things that trigger your symptoms. Limit alcohol consumption and follow a low-purine diet.
Reviewed By: Jeffrey Kauffman, MD, Sacramento Knee and Sports Medicine, Sacramento, CA. Review provided by VeriMed Healthcare Network.
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