chronic gout


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gout

(gowt) [Fr. goute, fr L. gutta, a drop]
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GOUT: Uric acid crystals and white blood cells in synovial fluid (orig. mag. ×500)
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GOUT
A form of arthritis marked by the deposition of monosodium urate crystals in joints and other tissues. Any joint may be affected, but gout usually begins in the knee or the first metatarsophalangeal joint of the foot. Synonym: monosodium urate deposition diseasetophus;

Symptoms

Most hyperuricemic people are asymptomatic between acute attacks. When an attack of acute gouty arthritis develops, it usually begins at night with moderate pain that increases in intensity to the point where no body position provides relief. Low-grade fever and joint inflammation (hot, exquisitely tender, dusky-red or cyanotic joints) may be present. See: illustration

Treatment

Colchicine, nonsteroidal anti-inflammatory agents, or corticosteroids are used to treat acute gouty attacks. Long-term therapy aims at preventing hyperuricemia by giving uricosuric drugs such as probenecid, or xanthine oxidase inhibitors such as allopurinol. Patients with gout have a tendency to form uric acid kidney stones. The diet should be well balanced and devoid of purine-rich foods, e.g., anchovies, sardines, liver, kidneys, sweetbreads, lentils, beer, wine, and other alcoholic beverages, because these raise urate levels. Fluid intake should be encouraged.

Patient care

During the acute phase, bedrest is prescribed for at least the first 24 hr, and affected joints are elevated, immobilized, and protected by a bed cradle. Analgesics are administered, and hot or cold packs applied, depending on which the patient finds most helpful. The patient is taught about these measures. Colchicine, nonsteroidal anti-inflammatory agents, prednisone, or other prescribed drugs are administered. Allopurinol may be prescribed as maintenance therapy after acute attacks to suppress uric acid formation and control uric acid levels, thus preventing future attacks. Patients should be warned to report adverse effects of allopurinol, e.g., drowsiness, dizziness, nausea, vomiting, urinary frequency, dermatitis. A low-purine diet is recommended. The importance of gradual weight reduction is explained if obesity, which places additional stress on painful joints, is a factor. If soft-tissue tophi are present, e.g., near joints in fingers, knees, or feet, the patient should wear soft clothing to cover these areas and should use meticulous skin care and sterile dressings to prevent infection of open lesions.

Surgery may be required to excise or drain infected or ulcerated tophi, to correct joint deformities, or to improve joint function. Even minor surgery may precipitate gouty attacks (usually within 24 to 96 hr after surgery); therefore, the patient should be instructed about this risk and medications administered as prescribed to prevent acute attacks. The goal of chronic management of gout is to maintain serum uric acid levels below 6 mg/dl. At these levels chronic complications of gout are limited.

abarticular gout

Periarticular gout.

chronic gout

A persistent form of gout.

lead gout

Goutlike symptoms associated with lead poisoning. Synonym: saturnine gout

periarticular gout

Gout that involves structures near the joints.
Synonym: abarticular gout

saturnine gout

Lead gout.

tophaceous gout

Gout marked by the development of tophi (deposits of sodium urate) in the joints and in the external ear.
References in periodicals archive ?
Acute and chronic gout arthritis are increasingly prevalent, but often poorly managed.
"About half the patients with chronic gout have significant impairment of renal function," said Dr.
Chronic gout, however, must be prevented by medications that reduce the formation of uric acid (Aloprim, Zyloprim, Uloric).
Biopharmaceutical company Savient Pharmaceuticals Inc (NASDAQ:SVNT) reported on Monday the launch of KRYSTEXXA in the EU to healthcare professionals and their patients suffering from refractory chronic gout (RCG) through a Named Patient Programme.
CONCLUSION: Tophaceous gout is a rare clinical manifestation that has been observed in patients with history of chronic gout. Although chronic gout and RA are common clinical entities, they seldom coexist.
Chronic gout, Silman adds, may occur with more of a gradual onset, and might look like osteoarthritis, but only affecting one joint.
But crucial, particularly in preventing repeat attacks and controlling chronic gout, is looking at how somebody's uric acid levels can be brought down.
M2 EQUITYBITES-December 1, 2010-Savient Pharmaceuticals reports first shipment of KRYSTEXXA for chronic gout in US(C)2010 M2 COMMUNICATIONS http://www.m2.com
Doherty, "Concordance of the management of chronic gout in a UK primary-care population with the EULAR gout recommendations," Annals of the Rheumatic Diseases, vol.
Smith is known to have suffered from chronic gout, and developed an addiction to painkillers that led to him being hospitalised with a perforated ulcer in 1999.
Chronic gout is often associated with the development of tophaceous deposits within cartilage, synovial membranes, bursae, and tendons.
"Some people can actually have chronic gout, in which they no longer have acute attacks but they really have more of a chronic arthritis because those crystals have deposited for such a long period of time," Dr.

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