chronic gout


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chronic gout

Etymology: Gk, chronos, time; L, gutta, drop
a persistent disorder of purine metabolism, characterized by abnormally high levels of serum uric acid and attacks of arthritis, with deposits of urates in the joints. The disorder may be familial and if untreated can lead to renal failure. See also gout.

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 ?
This will be the first presentation of initial data from the investigator-initiated TRIPLE (Tolerization Reduces Intolerance to Pegloticase and Prolongs the Urate Lowering Effect) study of a KRYSTEXXA tolerizing regimen in patients with chronic gout refractory to conventional therapies, also known as uncontrolled gout.
Austin Stack talked about major chronic diseases, the treatment options available for patients with Gout, Hyperuricemia, acute versus chronic Gout, risk and benefit of various medications in detail.
Acute and chronic gout arthritis are increasingly prevalent, but often poorly managed.
When symptoms cannot be relieved by these usual treatments, many patients may develop severe chronic gout with frequent arthritic flares, joint 1111 disease (often accompanied by deformity), chronic pain, inability to perform activities of daily living and impaired quality of life.
In early or even chronic gout, the features are normally negative on a plain radiograph.
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.
48) Subsequently, both rilonacept and canakinmab have been studied in a variety of clinical settings, for both acute and chronic gout and as gout prophylaxis during urate-lowering therapy.
Biopharmaceutical company Savient Pharmaceuticals Inc (NASDAQ:SVNT) revealed on Wednesday the submission of the Marketing Authorisation Application (MAA) to the European Medicines Agency (EMA) for KRYSTEXXA (pegloticase) for the treatment of chronic gout in adult patients refractory to conventional therapy.
Savient said it had received a so-called "complete response letter" from the FDA stating that the FDA "can not at this time approve" its application for the drug as a treatment for chronic gout.

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