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Gout - chronic
Definition
Gout is a disease involving uric acid deposits in the joints. The disorder causes pain, especially in the joints of the feet and legs. Chronic gout involves repeated episodes of joint pain.
See also: Gout - acute
Alternative Names
Gouty arthritis - chronic; Chronic gouty arthritis
Causes
Gout is caused by an overproduction of uric acid or a reduced ability of the kidney to get rid of uric acid. The exact cause is unknown. It is more common in males, postmenopausal women, and people with high blood pressure. Heavy alcohol use, diabetes, obesity, sickle cell anemia, and kidney disease also increase the risk.
The condition may also develop in people who take drugs that interfere with uric acid excretion.
Symptoms
Joint pain frequently starts during the night and is often described as throbbing, crushing, or excruciating. The affected joints show signs of warmth, redness, and tenderness. The pain tends to go away within several days. Chronic gout attacks, however, occur more often.
If several attacks of gout occur each year, it can lead to joint deformity and limited motion in joints. Uric acid deposits called tophi develop in cartilage tissue, tendons, and soft tissues. These tophi usually develop only after a patient has suffered from the disease for many years. Deposits also can occur in the kidneys, leading to chronic kidney failure.
Exams and Tests
There may be a current or previous medical history of acute arthritis in one joint. A physical examination of joints shows arthritis and tophi.
Tests that may be done include:
- Joint x-rays
- Synovial (joint) fluid analysis
- Uric acid blood test
- Uric acid urine test
Treatment
Chronic gouty arthritis is treated with drugs that help reduce uric acid levels. Medicines used to treat gout include:
- Allopurinol (the most commonly used)
- Probenecid
- Sulfinpyrazone
Patients should drink plenty of water or other fluids to reduce the risk of kidney complications.
Colchicine can be added to prevent further acute attacks. This drug can be stopped when uric acid levels are stable (usually after 3 months), but it can also be continued at low doses to help prevent further attacks.
Support Groups
See: Arthritis resources
Outlook (Prognosis)
Symptoms are generally worse in people who develop the disease before age 30.
Possible Complications
- Kidney stones
- Kidney failure
- Joint deformities
- Loss of mobility (patient becomes bedridden), rare
When to Contact a Medical Professional
Call your health care provider if symptoms of chronic gouty arthritis develop.
Prevention
Drugs that lower the serum uric acid concentration may prevent the development of chronic gouty arthritis in susceptible people.
Reviewed By: Steve Lee, DO, Rheumatology Fellow, Loma Linda University Medical Center, Loma Linda, CA. Review provided by VeriMed Healthcare Network.
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