Acute attack of gouty arthritis: Symptoms, Diagnosis & Treatments
Symptoms
The main symptoms of acute attack of gouty arthritis are severe pain, heat, and swelling, and the symptoms usually worsen at night. Most gouty arthritis also involve single joints. However, in this patient, polyarticular gout is observed in about 20% of cases. Most polyarticular gout patients were not treated with gout or multiple recurrence cases.
Diagnosis
The diagnosis of Gouty arthritis can be confirmed by puncturing the synovial fluid and observing the MSU through a polarizing microscope.
Hemorrhagic leukocytosis is observed in the blood, and ESR and CRP are increased, and uric acid is increased. However, when acute gouty attack is present, uric acid may be normal.
Treatments
In addition, ultrasound examination can be helpful in image examination, hyperechoic linear density (double contour sign) is a powerful current feature.
Acute attack The treatment of gouty arthritis is an anti-inflammatory drug. NSAIDs, colchicine, systemic / intraarticular glucocorticoids, and biologic agents. Treatment should be done as soon as possible, and discontinuation of treatment should be stopped 2-3 days after acute attack symptoms.
First, inhibition of COX-2 by NSAIDs inhibits inflammation and reduces the symptoms of gouty attack. It is most effective to start within 48 hours after the onset of symptoms. However, NSAIDs should not be used in patients with CKD, active duodenal or gastric ulcer, cardiovascular patients, or patients with an allergic reaction to NSAIDs.
In patients who can not use NSAIDs, they will use colchicine. In the case of colchicine, it should be done within 12 to 24 hours after symptoms appear. Benefits decreased after 72 to 96 hours of symptoms.
The patients treated with intraarticular glucocorticoids, intraarticular glucocorticoids, were used in patients with one or two actively inflamed joints.
Finally, patients who can not use NSAIDs or colchicine will use oral glucocorticoids.
The efficacy of oral glucocorticoids has been shown to be very good, but rebound attacks are relatively uncommon and are not used as first-line therapy. For this reason, slow tapering should be performed when oral glucocorticoid is used. In addition, because of the steroid agent, side effects such as hyperglycemia, mood change, and increased blood pressure are frequent and are not used as first line therapy.
The main symptoms of acute attack of gouty arthritis are severe pain, heat, and swelling, and the symptoms usually worsen at night. Most gouty arthritis also involve single joints. However, in this patient, polyarticular gout is observed in about 20% of cases. Most polyarticular gout patients were not treated with gout or multiple recurrence cases.
Diagnosis
The diagnosis of Gouty arthritis can be confirmed by puncturing the synovial fluid and observing the MSU through a polarizing microscope.
Hemorrhagic leukocytosis is observed in the blood, and ESR and CRP are increased, and uric acid is increased. However, when acute gouty attack is present, uric acid may be normal.
Treatments
In addition, ultrasound examination can be helpful in image examination, hyperechoic linear density (double contour sign) is a powerful current feature.
Acute attack The treatment of gouty arthritis is an anti-inflammatory drug. NSAIDs, colchicine, systemic / intraarticular glucocorticoids, and biologic agents. Treatment should be done as soon as possible, and discontinuation of treatment should be stopped 2-3 days after acute attack symptoms.
First, inhibition of COX-2 by NSAIDs inhibits inflammation and reduces the symptoms of gouty attack. It is most effective to start within 48 hours after the onset of symptoms. However, NSAIDs should not be used in patients with CKD, active duodenal or gastric ulcer, cardiovascular patients, or patients with an allergic reaction to NSAIDs.
In patients who can not use NSAIDs, they will use colchicine. In the case of colchicine, it should be done within 12 to 24 hours after symptoms appear. Benefits decreased after 72 to 96 hours of symptoms.
The patients treated with intraarticular glucocorticoids, intraarticular glucocorticoids, were used in patients with one or two actively inflamed joints.
Finally, patients who can not use NSAIDs or colchicine will use oral glucocorticoids.
The efficacy of oral glucocorticoids has been shown to be very good, but rebound attacks are relatively uncommon and are not used as first-line therapy. For this reason, slow tapering should be performed when oral glucocorticoid is used. In addition, because of the steroid agent, side effects such as hyperglycemia, mood change, and increased blood pressure are frequent and are not used as first line therapy.
