Alternate Names: Gout - chronic; Gouty arthritis - chronic
Causes and Risks: 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 mellitus, obesity, sickle cell anemia, and kidney disease, or it may follow drug therapy that interferes with uric acid excretion.
Gout has four stages: asymptomatic, acute, intercritical, and chronic. In acute gouty arthritis, there is a sudden onset of symptoms that usually involves 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.
Several attacks of gout may occur each year resulting in chronic joint symptoms such as joint deformity and limitation of motion in the affected joints. Uric acid deposits called tophi develop in cartilage tissue, tendons, and soft tissues. Deposits also can occur within the kidneys, leading to chronic renal failure.
Risk factors include recurrences of acute attacks of gouty arthritis, lack of preventative measures in those with prior attacks, kidney disease, diabetes mellitus, sickle cell anemia, or obesity. Men and postmenopausal women are at higher risk than younger women. The incidence is 2 out of 1,000 people.
Prevention: Drugs that lower the serum uric acid concentration may prevent the development of chronic gouty arthritis in susceptible people.
Symptoms:
- joint pain--persistent pain in many joints
- large crystal deposits (tophi) in joints, tendons, and soft tissue
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:
Treatment: Chronic gouty arthritis is treated by using uricosuric drugs (probenecid or sulfinpyrazone) or allopurinol (blocks the enzyme that produces uric acid) to decrease serum uric acid levels. Fluid intake should be increased to decrease the risk of kidney complications.
Colchicine may be used, in addition to uricosuric drugs or allopurinol, to prevent further acute attacks, since there is an increased tendancy to develop acute attacks during the first few weeks or months of treatment. Colchicine is usually discontinued when uric acid levels are stable (3 months).
Support Groups: The stress of illness can often be helped by joining a support group where members share common experiences and problems. See arthritis - support group.
Prognosis: Symptoms are generally worse in people who develop the disease before 30 years old.
Complications:
Call for an appointment with your health care provider if symptoms of chronic gouty arthritis develop.
