Gouty Arthritis

Gout is caused by the deposit of uric acid crystal in joints.

These crystals inflame and eventually may damage joints.

Early in the course of gout, there is severe pain, redness and swelling in the big toe. (This is called podagra). I feel like the foot is being held in a hot oven. This typically begins abruptly during the night. If untreated over a period of years many joints may become involved. Chronic Gouty Arthritis looks like Rheumatoid Arthritis in that there may be swelling and pain as well as deformity at the wrists, hands, elbows, knees and ankles. There may be deposits of uric acid (which is a chalky white substance) under the skin most commonly on the elbows, hands or feet. These deposits are called “tophi”. Uric acid may accumulate in the kidney causing kidney stones, or deposit inside of the kidney damaging kidney function.

Gout is a curable form of arthritis.

Uric acid retention is worsened by the use of alcohol, aspirin and diuretics (fluid pills).

Some people genetically overproduce uric acid and develop gout.

The diagnosis of Gout is made by removing fluid from a joint or from a tophus and demonstrating the presence of uric acid crystals using a polarizing microscope.

Treatment consists of avoiding alcohol and aspirin and reducing the use of diuretics if this is medically feasible.

Gout is treated with anti-inflammatory medication, Colchicine, temporary use of oral steroid or joint injection.

Allopurinol and Uloric prevent the formation of uric acid by the body and are eventually curative. These medications should be begun 6 weeks after the last gouty attack. Their dosage should be gradually increased to the point that the uric acid level in the blood is lowered to normal.

Benemid lowers the uric acid level by causing the kidney to excrete large quantities of uric acid.

Pegloticase also rapidly lowers the level of uric acid and is use for people who have not responded to other treatments for gout.