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Gouty Arthritis (Causes & Risk Factor (Menopausal women, medications…
Gouty Arthritis
Causes & Risk Factor
Menopausal women
medications that decrease renal uric acid excretion
Patients with a history of high alcohol intake, particularly beer and liquor, and ingestion of red meat or seafood
Hypertension
Diabetes mellitus
Renal insufficiency
Management
Gout is managed in the following 3 stages:
:red_flag: Treating the acute attack
:red_flag: Providing prophylaxis to prevent acute flares
:red_flag: Lowering excess stores of urate to prevent flares of gouty arthritis and to prevent tissue deposition of urate crystals
NSAIDs: resolution of pain and inflammation (eg, indomethacin, celecoxib, ibuprofen, naproxen)
:!!: Contraindications: Bleeding, Coagulopathy
Corticosteroids are indicated in patients who cannot tolerate NSAIDs
Allopurinol: hypouricemic agent of choice in patients prone to uric acid calculi.
:!!: Contraindication: renal dysfunction
Uricosuric agents: treat hyperuricemia by enhancing renal clearance of uric acid
:!!: Contraindication: renal calculi, renal impairment
Investigation
Aspiration of the affected joint and analysis of the joint fluid
Serum uric acid levels: hyperuricemia predisposes patients to acute gout
FBC: elevated WBC, inflammation
X-ray: helpful in chronic cases
Clinical features
symptoms
pain in the affected joint
Increased sensitivity of overlying skin
Redness over joints
Pain in the big toe
Joint swelling
Fever
Hx
Precipitants, including hyperuricemia, stress, trauma, infection, surgery, crash dieting, initiation of uric acid–lowering drugs, or initiation of drugs that can cause elevated uric acid levels
Family history of gout
Signs
Swelling of the affected joint
Erythema over the affected joint
Tenderness of the affected joint
Warmth of the involved area
Presence of a mass on the affected joint
Limitation of range of motion
Results from the deposition of monosodium urate crystals, creating intense inflammation in the joints or other soft tissues