Alternative names
Gouty arthritis - acute; Gout - acute

Definition
Acute gouty arthritis is an attack of a metabolic disease marked by uric acid deposits in the joints. The disorder causes painful arthritis, especially in the joints of the feet and legs.

Causes, incidence, and risk factors

Gout is caused by a defect in metabolism that results in an overproduction of uric acid, or a reduced ability of the kidney to eliminate uric acid. The exact cause of the metabolic defect is unknown. The condition may also develop in people with diabetes, obesity, sickle cell anemia, and kidney disease, or it may follow drug therapy that interferes with uric acid excretion.

Gout has 4 stages: asymptomatic (without symptoms), acute, intercritical, and chronic.

In acute gouty arthritis, symptoms develop suddenly and usually involve only one or a few joints. 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 subside in several days, but may recur at irregular intervals. Subsequent attacks usually have a longer duration. Some people may progress to chronic gouty arthritis, while others may have no further attacks.

The risk is greater in men, postmenopausal women, and people who use alcohol.

Symptoms

 
• Joint pain       o Begins suddenly       o Affects one or more joints (hip pain, knee pain, ankle pain, foot pain, shoulder pain, elbow pain, wrist pain, hand pain, or pain in other joints)       o The great toe, knee, or ankle joints are most often affected  
• Joint swelling of the affected joints  
• Stiffness of the joint  
• The joint may be warm and red  
• Fever may be present  
• Skin lump which may drain chalky material

Signs and tests
A physical examination of the joints shows acute arthritis.

 
• Synovial fluid analysis shows uric acid crystals.  
• Uric acid (blood test) may be elevated.  
• Joint X-rays may be normal.

The following tests might also be helpful:

 
• Uric acid - urine  
• Synovial biopsy  
• Blood differential

Treatment

The goals of treatment are mainly to stop the pain and inflammation associated with the initial attack, and to prevent future attacks.

Colchicine is one of the medications that is effective in reducing the pain, swelling, and inflammation associated with acute gout attacks. The pain often subsides within 12 hours of starting treatment, and is completely relieved in 48 hours.

The medication works by decreasing the inflammation caused by uric acid crystals within the joint. However, it does not decrease the uric acid levels in the bloodstream. Daily use of colchicine or allopurinol helps prevent future attacks.

Non-steroidal anti-inflammatory drugs (NSAIDs) can be very effective in treating the pain and inflammation of an acute gout attack if taken soon after symptoms start.

Corticosteroids can also be very effective. Your doctor may inject the inflamed joint with steroids to relieve the pain.

Codeine or other analgesics may occasionally be prescribed for pain relief. Increased fluid intake 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.

Expectations (prognosis)
Adequate treatment of acute attacks allows people to live a normal life. The acute form of the disease may progress to chronic disease. Since uric acid is normally eliminated by the kidneys, chronic gout may lead to formation of uric acid kidney stones.

Complications

 
• Side effects of medications  
• Chronic gouty arthritis  
• Kidney stones  
• Kidney dysfunction

Calling your health care provider
Call for an appointment with your health care provider if symptoms occur that are suggestive of acute gouty arthritis.

Prevention
The disorder itself may not be preventable, although some precipitating factors may include trauma, alcohol consumption, and dietary purines. Medications may reduce attacks in a person with gout.