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Gouty Arthritis (Symptoms and clinical presentation (Acute GA (extreme…
Gouty Arthritis
Symptoms and clinical presentation
Asymptomatic hyperuricemia
usually accidental finding
Elevated sUA
Acute GA
extreme pain for hours- weeks
Limited mobility
3-14 days if untreated
Crystal induced inflammation
Tophaceous gout
Tophi - sodium urate deposits
Late complication of hyperuricemia
Damage to surrounding soft tissue
joint destruction, pain, and nerve compression
Common sites
MTP
Helix of ear
olecranon bursae
Achilles tendon
Knees
Hands
Uric acid nephrolithiasis
Gouty nephropathy
Etiology and Pathogenesis
Disorder of Uric Acid metabolism
Urate crystals deposited in joints/soft tissue
Hyperuricemia
Dietary purines
Urate
Under-excretion ( less than or equal to 6.8mg/dL
Tissue nucleic acids
#
Endogenous purine synthesis
#
Risk Factors
Demographics
age
Male
Postmenopausal Women
Comorbitities
Hypertension
Cardiovascular disease
CKD
Diabetes
Dyslipidemia
Metabolic syndrome
Lifestyle
Obesity
Meat/Seafood rich diet
High alcohol intake
Frequent consumption of high-fructose corn syrup
Complications
Cardiovascular risk
Hypertension
Treatment
RIM
Resolve
NSAIDs
Cautions
Bleeding ulcers
Renal insufficiency
Heart failure
CAD
Liver disease
Corticosteroids
Prednisone
Methylprednisolone
Triamcinolone
Colchicine
Gout flares
Gout Prophylaxis
Initiate: Urate-lowering therapy
Target sUA <6mg/dL
anti-inflammatory prophylaxis
Allopurinol
Febuxostat
Probencid
Lesinurad
Maintain: treatment to control sUA
Continue ULT
Continue prophylaxis for 6 months
Track sUA levels
Prevention of recurrent GA