Health Encyclopedia

Acute gouty arthritis

Definition

Acute gouty arthritis is a sudden attack of pain in the joints, especially in the feet and legs, that occur when uric acid builds up in the joints.

Alternative Names

Gouty arthritis - acute; Gout - acute

Causes, incidence, and risk factors

Gout is caused by an overproduction of uric acid or a reduced ability of the kidney to get rid of uric acid. The exact cause is unknown. It is more common in males, postmenopausal women, and people who drink alcohol.

The condition may also develop in people with:

The condition may occur after taking medicines that interfere with uric acid excretion.

Gout has 4 stages:

Asymptomatic
Acute
Intercritical
Chronic

This article discusses acute gouty arthritis only.

Symptoms

Symptoms develop suddenly and usually involve only one or a few joints. The big toe, knee, or ankle joints are most often affected.

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 go away in several days, but may return from time to time. Additional attacks usually last long. Some people may progress to chronic gouty arthritis, while others may have no further attacks.

Specific symptoms include:

Fever (sometimes)
Joint pain
Joint swelling of the affected joints
Join stiffness
Joint redness
Skin lump which may drain chalky material

Signs and tests

Tests that may be done include:

Blood differential
Joint x-rays (may be normal)
Synovial biopsy
Synovial fluid analysis (shows uric acid crystals)
Uric acid- blood
Uric acid - urine

Treatment

A prescription medicine called colchicine helps reduce pain, swelling, and inflammation associated with acute gout attacks. The medication decreases the inflammation caused by uric acid crystals within the joint. It does not decrease the uric acid levels in the bloodstream.

The pain often goes away within 12 hours of starting treatment, and is completely relieved in 48 hours. Daily use of colchicine or allopurinol helps prevent future attacks.

Your doctor may also recommend that you take non-steroidal anti-inflammatory drugs (NSAIDs) as soon as symptoms start to relieve pain and inflammation. Strong painkillers such as codeine may occasionally be prescribed.

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

Drinking more fluids helps 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)

Proper treatment of acute attacks allows people to live a normal life. However, the acute form of the disease may progress to chronic gout.

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 you have symptoms of acute gouty arthritis.

Prevention

The disorder itself may not be preventable, but you may be avoid to avoid things that trigger your symptoms. Limit alcohol consumption and follow a low-purine diet.

Review Date:4/26/2007
Reviewed By:Steve Lee, DO, Rheumatology Fellow, Loma Linda University Medical Center, Loma Linda, CA. Review provided by VeriMed Healthcare Network.

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