Chronic gouty arthritis

Alternative names
Gout - chronic; Gouty arthritis - chronic

Definition
Gouty arthritis is the name for an attack of a metabolic disease marked by uric acid deposits in the joints. The disorder causes pain, especially in the joints of the feet and legs. Patients with chronic gout may have repeated episodes of gouty arthritis.

Causes, incidence, and risk factors
Gout is caused by a defect in metabolism which results in an overproduction of uric acid or leads to reduced ability of the kidney to eliminate uric acid. The exact cause is unknown. Risk is increased in males, postmenopausal women, and people with hypertension. Heavy alcohol use, diabetes, obesity, sickle cell anemia, and kidney disease also increase risk, as does lack of preventative measures in those with prior attacks.

The condition may also develop in people who take drugs which interfere with uric acid excretion.

Symptoms

     
  • An attack of chronic gout is similar to an attack of acute gouty arthritis. Symptoms come on suddenly, usually involving only one or a few joints. The pain frequently starts during the night and is often described as throbbing, crushing, or excruciating. The affected joints show signs of warmth, redness, and tenderness. The pain tends to subside within several days. Chronic gout attacks, however, occur more often.  
  • If several attacks of gout occur each year this may cause chronic symptoms such as joint deformity and limitation of motion in affected joints. Uric acid deposits called tophi develop in cartilage tissue, tendons, and soft tissues. These tophi usually develop only after a patient has suffered from the disease for many years. Deposits also can occur in the kidneys, leading to chronic renal failure.

Signs and tests
There may be a current or previous medical history of acute arthritis in one joint. A physical examination of joints shows arthritis and tophi.

Tests that indicate gouty arthritis include:

     
  • Synovial fluid analysis that detects uric acid crystals  
  • Elevated uric acid level  
  • Joint x-rays which show damage consistent with gouty arthritis

Treatment
Chronic gouty arthritis is treated with drugs like probenecid or sulfinpyrazone, which reduce uric acid levels. Another approach is to use allopurinol, which blocks the enzyme that produces uric acid, helping to reduce the level of this chemical. Patients should drink plenty of water or other fluids to decrease the risk of kidney complications.

Colchicine can be added to prevent further acute attacks. This drug can be discontinued when uric acid levels are stable (usually after 3 months), but it can also be continued at low doses to help prevent further attacks.

Support Groups
The stress of illness may be eased by joining a support group of members who share common experiences and problems. See arthritis - support grou

Expectations (prognosis)
Symptoms are generally worse in people who develop the disease before age 30.

Complications

     
  • Kidney stones  
  • Kidney failure  
  • Joint deformities  
  • Loss of mobility (patient becomes bedridden), rare

Calling your health care provider
Call your health care provider if symptoms of chronic gouty arthritis develop.

Prevention
Drugs that lower the serum uric acid concentration may prevent the development of chronic gouty arthritis in susceptible people.

Johns Hopkins patient information

Last revised: December 3, 2012
by Martin A. Harms, M.D.

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