Gouty Arthritis: Symptoms, Causes, Risk Factors, Diagnosis and Treatment

It is a rheumatic disease of arthritis characterized by elevated levels of uric acid, hyperuricemia, inflammation and pain.

It has been described throughout history as the “King’s Disease.” This is because high levels of uric acid are often caused by the intake of food such as wine, red meat and shrimp.

Progression of the disease

The patient often experiences an initial period of asymptomatic hyperuricemia, in which if the levels are not reduced, an episode of acute gouty inflammation will occur over time.

High levels cause the formation of uric acid crystals, which causes damage to the joints.

The inflammation can cause damage to the cartilage, bone, bursa, tendons and organs such as the kidneys and the heart.

The three stages of gouty arthritis are:

Asymptomatic hyperuricemia: Uric acid levels are elevated, but symptoms have not yet appeared
The initial gout attacks: appearance of acute gouty arthropathy. The intervals between acute attacks may decrease if uric acid levels are not controlled.
Chronic gout: characterized by the formation of tophi, which are caused by crystal deposits.

Potential complications associated with uncontrolled gouty arthritis

Hypertension.
Chronic kidney disease.
Congestive heart failure
Metabolic syndrome.
Type 2 diabetes mellitus.
Atherosclerosis

Causes of gouty arthritis

Gouty arthritis is caused by the excess of uric acid in the bloodstream and the accumulation of uric acid crystals in the tissues of the body.

Deposits of uric acid crystals in the joint cause inflammation of the joint that causes pain, redness, heat and swelling.

Uric acid is normally found in the body as a byproduct of the way the body breaks down certain proteins called purines.

The causes of an elevated level of uric acid in the blood (hyperuricemia) include genetics, obesity, certain medications such as diuretics (water pills) and decreased chronic kidney function.

 

What are the risk factors for gouty arthritis?

There are many risk factors for gouty arthritis. Gouty arthritis is more common after surgery, trauma and dehydration.

Certain medications, such as diuretics (commonly referred to as water pills), that treat high blood pressure and increase the level of uric acid in the bloodstream are risks for gouty arthritis.

Surprisingly, medications that lower the level of uric acid in the bloodstream, such as allopurinol (Zyloprim, Aloprim), can also initially cause an outbreak of gouty arthritis.

This is because anything that increases or decreases the level of uric acid can cause an outbreak of gouty arthritis by causing uric acid crystals to deposit in a joint.

Aspirin in low doses can precipitate attacks of gouty arthritis. The treatment of certain types of cancer can cause gouty arthritis due to the high levels of uric acid that are released when the cancer cells are destroyed.

Degenerative arthritis also makes the affected joints more likely to be the site of a gouty arthritis attack.

 

What are the symptoms and signs of gouty arthritis?

 

The symptoms and signs characteristic of gouty arthritis are:

Sudden onset of joint pain.
Swelling of the joints.
Heat in the affected area.
Redness of the joint.

These symptoms and signs usually affect only one joint. The pain is usually intense, reflecting the severity of the inflammation in the joint.

The affected joint is usually very sensitive to the touch to the point that some people with attacks of gouty arthritis experience pain of something as simple as taking the sheets off the bed over the inflamed joint.

The affected joint becomes inflamed. The medical term for excess fluid in a joint is a “joint effusion.”

Gouty arthritis often involves joints in the lower extremities. The classic location for the gout to occur is the big toe. Podagra is the medical term for inflammation at the base of the big toe.

Gouty arthritis can also affect the foot, knee, ankle, elbow, wrist, hands or almost any joint in the body.

When gouty arthritis is more severe or prolonged, several joints may be affected at the same time. This causes joint pain and stiffness in multiple joints.

Another sign of gouty arthritis is the presence of tophi. A typhoid is a hard nodule of uric acid that is deposited under the skin.

Tophi can be found in various parts of the body, commonly in the elbows, in the cartilage of the upper part of the ear and on the surface of other joints.

When a tofo is present, it indicates that the body is substantially overloaded with uric acid.

This indicates that the level of uric acid in the bloodstream has generally been high for years. The presence of tophi indicates tophaceous gouty arthritis and treatment with medications is necessary.

Gouty arthritis untreated for a long time can cause joint damage and physical deformities.

Kidney stones can be a sign of gouty arthritis, since uric acid crystals can be deposited in the kidney and cause kidney stones.

What types of doctors treat gouty arthritis?

Rheumatologists traditionally have experience in the diagnosis and treatment of gout, especially in complicated situations.

Other specialists, such as internists, general practitioners, family medicine doctors and orthopedists can handle simple cases of gout.

Nephrologists can treat patients with uric acid-lowering drugs, such as allopurinol, to prevent damage to the kidneys, which can occur with high levels of uric acid (hyperuricemia).

 

How do health care providers diagnose gouty arthritis?

 

The most reliable method to diagnose gout is by demonstrating uric acid crystals in the joint fluid that was removed from an inflamed joint (arthrocentesis).

Specially trained doctors, such as a rheumatologist or orthopedist, can carefully remove fluid from the joint. The fluid is then examined under a microscope to determine if there are uric acid crystals.

This is important because other conditions and medical conditions, such as pseudogout (a type of arthritis caused by the deposition of calcium pyrophosphate crystals) and infection, may have symptoms similar to gout.

 

What are the treatments and home remedies for gouty arthritis?

When gout is mild, uncommon and uncomplicated, it can be treated with changes in diet and lifestyle.

However, studies have shown that even the most rigorous diet does not reduce serum uric acid enough to control severe gout, and therefore medications are usually necessary.

When attacks are frequent, renal stones of uric acid have been produced, there are tophi or there is evidence of joint damage due to gout attacks, medications are generally used to lower the level of uric acid in the blood.

Medications for the treatment of gout are usually classified into one of three categories:

Drugs that reduce uric acid,
Prophylactic medications (medications used together with medications that reduce uric acid to prevent a gout outbreak).
Rescue medications to provide immediate relief from gout pain.

Medications that reduce urate are the primary treatment for gout.

These medicines decrease the total amount of uric acid in the body and decrease the level of serum uric acid.

For most patients, the goal of drugs that decrease uric acid is to achieve a serum uric acid level of less than 6 mg / dL.

These medications are also effective treatments to reduce the size of tophi, with the ultimate goal of eradicating them.

Medications that decrease uric acid include allopurinol (Zyloprim, Aloprim), febuxostat (Uloric), probenecid, and pegloticase (Krystexxa).

Prophylactic medications are used for approximately the first six months of therapy with a medication to lower high uric acid levels to prevent outbreaks of gout or decrease the number and severity of outbreaks.

This is because any medication or intervention that increases or decreases the level of uric acid in the bloodstream can trigger a gout attack.

Colcrys (colchicine) and any of the NSAIDs (non-steroidal anti-inflammatory drugs) such as indomethacin (Indocin, Indocin-SR), diclofenac (Voltaren, Cataflam, Voltaren-XR).

Ibuprofen (Advil) or naproxen sodium (Aleve) are frequently used as prophylactic drugs to prevent gout outbreaks during the reduction of uric acid.

When taking one of these prophylactic or preventive medications during the first six months of treatment with allopurinol, febuxostat or probenecid, the risk of having a gout attack during this time decreases.

Prophylactic medications are not used in combination with Krystexxa.

The third category of medications are those used during attacks of acute gout to decrease pain and inflammation.

Both colchicine (Colcrys) and NSAIDs can be used during an acute gout attack to decrease inflammation and pain.

Corticosteroids, such as prednisone, methylprednisolone (Medrol), and prednisolone (Orapred), may also be used during an acute gout flare.

However, the total dose of steroids is generally limited due to potential side effects, such as cataract formation and bone loss.

Steroid medications are extremely useful in treating outbreaks of gout in patients who can not take colchicine or NSAIDs.

 

Home remedies for gouty arthritis

Home remedies for an attack of acute gout include drinking lots of water.

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) and naproxen sodium (Aleve), can be used when there are no contraindications, such as decreased kidney function or stomach ulcers.

Home remedies can also be very beneficial for the management of chronic gout.

The dietary modifications detailed above can be very effective in certain patients. Drinking plenty of water to stay well hydrated can be beneficial in preventing gout attacks.