This process is caused by an overproduction or under excretion of uric acid. Certain common medications, alcohol, and dietary foods are known to be contributory factors. Acute gout will typically manifest itself as an acutely red, hot, and swollen joint with excruciating pain. These acute gouty flare- ups respond well to treatment with oral anti- inflammatory medicines and may be prevented with medication and diet changes. Recurrent bouts of acute gout can lead to a degenerative form of chronic arthritis called gouty arthritis. I. Background. Gout is an ancient and common form of inflammatory arthritis, and is the most common inflammatory arthritis among men. Gout may remit for long periods, followed by flares for days to weeks, or can become chronic. The presence of elevated levels of uric acid in. Uric acid is a metabolic product. Diagnosis, Treatment, and Prevention of Gout. Although febuxostat is superior to 300 mg allopurinol at lowering serum uric acid levels. Gout is caused by an uncontrolled metabolic disorder, hyperuricemia, which leads to the deposition of monosodium urate crystals in tissue. Hyperuricemia means too much uric acid in the blood. Uric acid is a metabolic product resulting from the metabolism of purines (found in many foods and in human tissue). Hyperuricemia is caused by an imbalance in the production and excretion of urate, i. Hyperuricemia is not the same as gout. Asymptomatic hyperuricemia does not need to be treated. Risk factors for gout include being obese, having insulin resistance, metabolic syndrome, hypertension, congestive heart failure, alcohol intake (beer and spirits more than wine), diuretic use, a diet rich in meat and seafood, and poor kidney function. Gout can be viewed in four stages. Asymptomatic tissue deposition occurs when people have no overt symptoms of gout, but do have hyperuricemia and the asymptomatic deposition of crystals in tissues. The deposition of crystals, however, is causing damage. Acute flares occur when urate crystals in the joint(s) cause acute inflammation. A flare is characterized by pain, redness, swelling, and warmth lasting days to weeks. Pain may be mild or excruciating. Most initial attacks occur in lower extremities. The typical presentation in the metatarsophalageal joint of the great toe (podagra) is the presenting joint for 5. About 8. 0% of people with gout do have podagra at some point. Uric acid levels may be normal in about half of patients with an acute flare.
Gout may present differently in the elderly, with many joints affected. Intercritical segments occur after an acute flare has subsided, and a person may enter a stage with clinically inactive disease before the next flare. The person with gout continues to have hyperuricemia, which results in continued deposition of urate crystals in tissues and resulting damage. Intercritical segments become shorter as the disease progresses. Chronic gout is characterized by chronic arthritis, with soreness and aching of joints. People with gout may also get tophi (lumps of urate crystals deposited in soft tissue). Urate crystals are negatively birefringent under polarized light. Infection must be ruled out. The treatment goals are to end the pain of acute flares and prevent future attacks and the formation of tophi and kidney stones. Therapy for acute flares consists of nonsteroidal anti- inflammatory drugs, steroids, and colchicine. Diet and lifestyle modifications (weight loss, avoiding alcohol, reducing dietary purine intake) may help prevent future attacks. Changing medications (e. Preventive therapy to lower blood uric acid levels in people with recurrent acute flares or chronic gout usually involves allopurinol or newer drugs (febuxostat and pegloticase). Prevalence. The prevalence of gout among US adults in 2. Incidence. The incidence of gout among black men was almost twice that among white men (3. The cumulative incidence of gout was 1. A Rochester Epidemiology Project study showed an increase in the incidence of gout from 4. Male to female ratios were 3. Considering primary gout (excluding people with gout on diuretics), the incidence of gout increased from 2. Top of Page. IV. Mortality. Using data from the Health Professionals Follow- Up Study researchers found that men with gout were shown to have an increased risk of all- cause mortality and cardiovascular disease (CVD) mortality compared with men without gout (the multivariate relative risks were 1. Hospitalizations. In 2. 01. 0, gout and other crystal arthropathies accounted for 2. Top of Page. VI. Ambulatory Care. Gout was listed for 4. This amounts to 5% of all ambulatory visits among adults with arthritis and other rheumatic conditions. Costs. The estimated medical expenditures attributable to gout were $2,8. Top of Page. VIII. Impact on Health- Related Quality of Life (HRQOL)A systematic review of 2. Top of Page. IX. Unique Characteristics. Unlike most types of arthritis, which are chronic, gout is typically episodic, characterized by painful flares lasting days or weeks followed by long periods without symptoms. Burns C, Wortmann R. L. Burns, Christopher, and Robert L. In: Imboden JB, Hellmann DB, Stone JH. Imboden J. B., Hellmann D. B., Stone J. H. CURRENT Rheumatology Diagnosis & Treatment, 3e. New York, NY: Mc. Graw- Hill; 2. 01. Accessed April 2, 2. Neogi T. N Engl J Med 2. Krishnan E. Chronic kidney disease and the risk of incident gout among middle- aged men. Gout Classification Criteria. An American College of Rheumatology/European League Against Rheumatism. Collaborative Initiative. Arthritis Rheum Vol. October 2. 01. 5, pp 2. Prevalence of gout and hyperuricemia in the US general population: The National Health and Nutrition Examination Survey 2. Global epidemiology of gout: prevalence, incidence and risk factors. Nature Reviews Rheumatology. Racial differences in gout incidence in a population- based cohort: Atherosclerosis Risk in Communities Study. Independent impact of gout on mortality and risk for coronary heart disease. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2. Arthritis. Cisternas MG , Murphy LB, Pasta DJ, Yelin EH, Helmick CG. Annual medical care expenditures among US adults with gout, 2. S1. 0): S8. 88. Chandratre P, Roddy E, Clarson L, Richardson J, Hider SL, Mallen CD. Health- related quality of life in gout: a systematic review. Rheumatology (Oxford). Resources Top of Page.
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