Gout: Symptoms, Diagnosis & Treatments
Symptoms
Gout is a crystal-related arthropathy caused by the accumulation of monosodium urate (MSU) crystals in joints and soft tissues. Uric acid is the last metabolite of purine. When plasma urate saturation exceeds 7.0 mg / dL, it is called hyperuricemia and MSU occurs from this point. It is most common in adult men and is associated with age, BSA, weight, creatinine, alcohol, and hypertension. Gouty arthritis progresses to four stages of asymptomatic hyperuricemia, acute gouty arthritis, intercritical gout, and chronic tophaceous gout. First, asymptomatic hyperuricemia shows hyperuricemia but not arthritis, tophi, and nephrolithiasis. In acute gouty arthritis, severe pain, redness, warmth, swelling, and disability occur. Peaks appear in 12 to 24 hours, and all symptoms disappear within a few days to a few weeks. Acute gout attacks occur frequently during the night or early morning, resulting in pain that often causes them to wake up. In addition, 80% of the initial attack occurs only in a single joint and occurs most often in the big toe of multiple joints. It is also less common than peripheral involvement, but can also occur in spine and sacroiliac joints. Acute gout attacks are self-limited without special treatment, so patients are not treated well. When the acute gout attack disappears, an intercritical gout is found. The duration of the asymptomatic period differs from patient to patient, usually within 2 years after the 1st gout attack. During this period, symptoms do not appear, but as the tophaceous material accumulates, bony erosion occurs and eventually leads to chronic gouty arthropathy. Chronic tophaceous When you reach the gout stage, the tophi is formed around the connective tissue and sometimes it is visible and touched. Also, mild, persistent joint pain & swelling occurs and gouty attack occurs in several places.
Diagnosis
The diagnosis of Gout is based on repeated episodes of monoarticular arthritis or inflammation peaking within 24 hours, disappearing within a few days, unilateral 1st MTP joint pain, visible or palpable lesion seen as tophi being palpated, hyperuricemia, If there is suspicious gout, such as the characteristic findings in the image study, arthrocentesis can be performed and the MSU crystal can be diagnosed by polarizing light microscopy. Gout requires differential diagnosis with septic arthritis, trauma, CPPD disease, BCP crystal disease, rheumatoid arthritis, dactylitis, and osteomyelitis.
Treatments
Treatment of Gout rapidly responds to acute attack with colchicine, NSAIDs, and corticosteroids, and the goal is to keep serum urate below 6 mg / dL. Anti inflammatory agents include colchicine, NSAIDs, and glucocorticoids. Urea lowering agents include allopurinol, benzbromarone, probenecid, and sulfinpyrazone. Other drugs include febuxostat, uricase, and losartan. If you need to use a drug, you may have chronic gout or tophi if you have more than one attack per year. First, it helps relieve inflammation with anti-inflammatory agent. If the urine lowering agent is used first, the urine lowering agent will be used. If the urate lowering agent is used first, the urine will be suddenly changed and the pain will become worse. The most commonly used drug of lowering agents is allopurinol, which inhibits uric acid production, and benzbromarone, which promotes uric acid release.
Gout is a crystal-related arthropathy caused by the accumulation of monosodium urate (MSU) crystals in joints and soft tissues. Uric acid is the last metabolite of purine. When plasma urate saturation exceeds 7.0 mg / dL, it is called hyperuricemia and MSU occurs from this point. It is most common in adult men and is associated with age, BSA, weight, creatinine, alcohol, and hypertension. Gouty arthritis progresses to four stages of asymptomatic hyperuricemia, acute gouty arthritis, intercritical gout, and chronic tophaceous gout. First, asymptomatic hyperuricemia shows hyperuricemia but not arthritis, tophi, and nephrolithiasis. In acute gouty arthritis, severe pain, redness, warmth, swelling, and disability occur. Peaks appear in 12 to 24 hours, and all symptoms disappear within a few days to a few weeks. Acute gout attacks occur frequently during the night or early morning, resulting in pain that often causes them to wake up. In addition, 80% of the initial attack occurs only in a single joint and occurs most often in the big toe of multiple joints. It is also less common than peripheral involvement, but can also occur in spine and sacroiliac joints. Acute gout attacks are self-limited without special treatment, so patients are not treated well. When the acute gout attack disappears, an intercritical gout is found. The duration of the asymptomatic period differs from patient to patient, usually within 2 years after the 1st gout attack. During this period, symptoms do not appear, but as the tophaceous material accumulates, bony erosion occurs and eventually leads to chronic gouty arthropathy. Chronic tophaceous When you reach the gout stage, the tophi is formed around the connective tissue and sometimes it is visible and touched. Also, mild, persistent joint pain & swelling occurs and gouty attack occurs in several places.
Diagnosis
The diagnosis of Gout is based on repeated episodes of monoarticular arthritis or inflammation peaking within 24 hours, disappearing within a few days, unilateral 1st MTP joint pain, visible or palpable lesion seen as tophi being palpated, hyperuricemia, If there is suspicious gout, such as the characteristic findings in the image study, arthrocentesis can be performed and the MSU crystal can be diagnosed by polarizing light microscopy. Gout requires differential diagnosis with septic arthritis, trauma, CPPD disease, BCP crystal disease, rheumatoid arthritis, dactylitis, and osteomyelitis.
Treatments
Treatment of Gout rapidly responds to acute attack with colchicine, NSAIDs, and corticosteroids, and the goal is to keep serum urate below 6 mg / dL. Anti inflammatory agents include colchicine, NSAIDs, and glucocorticoids. Urea lowering agents include allopurinol, benzbromarone, probenecid, and sulfinpyrazone. Other drugs include febuxostat, uricase, and losartan. If you need to use a drug, you may have chronic gout or tophi if you have more than one attack per year. First, it helps relieve inflammation with anti-inflammatory agent. If the urine lowering agent is used first, the urine lowering agent will be used. If the urate lowering agent is used first, the urine will be suddenly changed and the pain will become worse. The most commonly used drug of lowering agents is allopurinol, which inhibits uric acid production, and benzbromarone, which promotes uric acid release.
