What Is Gouty Arthritis?

Gouty arthritis is caused by the accumulation of urate in the joint capsule, bursa, cartilage, bone and other tissues, which causes lesions and inflammatory reactions. It has many genetic factors and is more common in men over 40. The first metatarsophalangeal joint can also occur in other larger joints, especially the ankle and foot joints.

Basic Information

English name

goutyarthritis

Visiting department

orthopedics

Multiple groups

Men over 40

Common locations

First metatarsophalangeal joint

Causes of gouty arthritis

Uric acid is the final product of purine metabolism. Gout is caused by long-term purine metabolism disorders and increased blood uric acid. If the patient has no clinical symptoms and the blood uric acid concentration is higher than normal, it is medically called "hyperuricemia." If the uric acid concentration in the blood reaches a saturated solubility, these substances eventually form crystals and accumulate in soft tissues. Eventually leads to an inflammatory reaction in the body. Gout can be caused by diet, weather changes such as sudden changes in temperature and pressure, and trauma. Familial tendencies and genetic patterns are unclear.

Clinical manifestations of gouty arthritis

Usually divided into 3 phases:

Acute arthritis

Sudden onset at night, severe pain in the affected joints, the first joint often involves the first metatarsophalangeal joint, followed by the ankle and knee. Redness, swelling, heat and tenderness of joints, general weakness, fever, headache, etc. Can last 3 to 11 days. Drinking, overeating, overwork, catching cold, stimulating surgery, and stress can all be triggers.

2. Intermittent period

For several months or years, with the recurrence of the disease, the interval becomes shorter, the disease period prolongs, and the number of diseased joints increases, gradually turning into chronic arthritis.

3. Chronic arthritis

The average period from acute onset to chronic arthritis was about 11 years, with joint deformities and movement restrictions. About 30% of patients can see gout stones and complication of kidney, and ureteral stones. There are hypertension, renal and cerebral arteriosclerosis, and myocardial infarction. A small number of patients die from renal failure and cardiovascular accidents.

Gouty Arthritis Diagnosis

Clinical manifestations, laboratory tests, and X-ray examinations are helpful for diagnosis, but urate crystals can be found by synovial membrane or synovial fluid, because uric acid levels are sometimes increased in psoriasis and rheumatoid arthritis. The diagnostic criteria are:

1. More than one episode of acute arthritis, peaking within 1 day.

2. Acute arthritis is limited to individual joints, and the whole joint is dark red. First metatarsophalangeal joint swelling and pain.

3. Acute exacerbation of unilateral sacroiliitis.

4. Have gout stones.

5. Hyperuricemia.

6. Asymmetric joint swelling and pain.

7. Seizures can stop on their own.

Those who have more than 3 conditions and can exclude secondary gout can be diagnosed.

Differential diagnosis of gouty arthritis

Cellulitis

Often accompanied by systemic symptoms, blood uric acid does not increase.

2. Crystal arthritis

Including pseudogout, hydroxyapatite deposition, and steroid crystalline arthritis, a clear pathological diagnosis is required.

3. Rheumatoid arthritis

When gout affects multiple joints, it is often misdiagnosed as rheumatoid arthritis. It requires careful analysis of medical history, detection of rheumatoid factor and even pathology to identify.

4. Negative spondyloarthropathy

Gouty arthritis with asymmetric large joint involvement in the lower extremities should be distinguished from ankylosing spondylitis. It should be noted whether patients have lower back pain, especially inflammatory lower back pain. In addition, HLA-B27 and sacroiliac joint imaging can be performed for further identification.

Gouty Arthritis Treatment

Treatment of acute phase

The trigger should be eliminated and the acute onset of arthritis should be controlled. Common drugs include:

(1) Non-steroidal anti-inflammatory drugs Analgesics preferred in the acute phase, such as diclofenac sodium or diclofenac potassium, or celecoxib, meloxicam and the like. Discontinue medication after symptoms have been controlled. Monitor blood creatinine levels during application.

(2) Colchicines Non-steroidal anti-inflammatory drugs can be considered for use when they are ineffective. They should be taken orally in small amounts until the symptoms are relieved or the drug is discontinued. Monitor adverse reactions during medication.

(3) Glucocorticoids If there is a patient with renal insufficiency, glucocorticoids can be considered in the acute phase, and Debaosong intramuscular injection is often used clinically.

2. Treatment in remission

The main purpose is to reduce blood uric acid levels and prevent another acute attack.

(1) Drugs that inhibit uric acid production Allopurinol is gradually increased from a small amount according to the uric acid level.

(2) benzbromarone, a drug that promotes uric acid excretion .

It should be emphasized that uric acid-lowering drugs may induce acute arthritis, so it should not be used in the acute stage, and such drugs should be used from a small dose.

3. Treatment of asymptomatic hyperuricemia

General treatments include weight loss, blood lipid control, reduction of unnecessary diuretics, and diet control. At the same time, comorbid hypertension, hyperlipidemia, hyperglycemia and other diseases are actively treated. The timing of the application of uric acid lowering drugs is inconclusive. About 5% to 15% of patients with asymptomatic hyperuricemia develop gout. If there is cardiovascular disease or other high-risk factors, regular uric acid lowering treatment should be started when the blood uric acid continues to exceed 480umol / L. If there are no high risk factors such as cardiovascular disease, continuous uric acid lowering treatment can be started when the blood uric acid is higher than 540umol / L.

Gouty Arthritis Prevention

Diet

Low-purine, low-fat, low-salt, low-protein diet, and should quit alcohol, eat more alkaline foods to prevent acute gout, and facilitate uric acid excretion.

2. Drink plenty of water, the daily amount of water should be greater than 2000ml.