GOUT

Demographics Affects middle-aged to elderly men postmenopausal and elderly women (usually have OA and HPN causing mild renal insufficiency, and are usually receiving diuretics)

Joints Affected Acute Monoarticular Gout Involves initially one joint - metatarsophalangeal joint of the first toe, but can progress and may involve other joints such as tarsal joints, ankles, and knees elderly patients or in advanced disease, finger joints may be involved

Chronic Gout chronic nonsymmetric synovitis, causing potential confusion with rheumatoid arthritis

Signs and Sypmtoms 90% acute monoarticular arthritis involving the smaller, lower-extremity joint 50% presents initially with inflammation of metatarsophalangeal joint of the first toe, commonly called as podagra. acute attacks begin abruptly and reach maximum intensity within 8-12 hours. joints are red, hot, and exquisitely tender. untreated, the first attacks resolve spontaneously in less than 2 weeks

Signs and Symptoms history of intermittent inflammatory arthritis, in which the joints return to normal between attacks 10% presents initiallly with polyarticular arthritis, esp women w/ renal insuffciency and on thiazide

Clinical Course Acute flares of gout can result from increased levels of serum uric acid: consumption of beer or liquor, overconsumption of foods with high purine content, Trauma Hemorrhage Dehydration Use of medications that elevate levels of uric acid

Clinical Course The pattern of symptoms in untreated gout change over time attacks become more polyarticular. inflammation in a given joint may become less intense. more proximal and upper-extremity joints become involved. attacks occur more frequently and last longer

Clinical Course Eventually, patients may develop chronic polyarticular arthritis, sometimes nearly symmetrical, that can resemble rheumatoid arthritis can also cause inflammation in other synovial- based structures such as bursae and tendons. They tend to develop TOPHI (collection of urate crystals in soft tissues) usually after 10 years in untreated patients, particularly in women receiving diuretics

X-rays Findings Early in the disease radiographic studies may only confirm clinically evident swelling. For chronic tophaceous gout, may show: cystic changes, well-defined erosions with sclerotic margins (often with overhanging bony edges), and soft tissue masses.

Pharmacologic Treatement NSAIDS Indomethacin 25–50 mg TID Ibuprofen 800 mg TID Diclofenac 50 mg TID Cochicine: 1-2 tabs of 0.6-mg tablets every 6–8 h over several days Oral Corticosteroids: prednisone, 30–50 mg/d as the initial dose and gradually tapered with the resolution of the attack

Pharmacologic Treatment Ultimate goal is to correct the hyperuricemia Usually with Allopurinol 300mg OD