In gout, monosodium urate crystals are deposited in tissue, causing inflammation and severe pain of relatively rapid onset, usually in a single joint. It occurs in three to four out of 1,000 persons, and 90% to 95% of patients are men over age 30. One in four have a family history of gout. Once called “the rich man’s disease” because of its association with overindulgence in food and alcohol, this metabolic disorder can be exacerbated by poor diet. Primary gout is the result of overproduction or under excretion of uric acid. Secondary gout is the result of myeloproliferative diseases, lead poisoning, enzyme deficiencies, or renal failure. Left untreated, gout may lead to a chronic arthritis. Symptoms & Signs Common signs and symptoms of gout include
- Pain in a single joint, often at the base of the great toe, but can be in other joints of the feet, fingers, wrists, elbows, knees, and ankles
- “Exquisite” pain and tenderness
- Swelling, heat, and stiffness of joint
- Shiny red or purple coloration of joint
- Fever up to 39°C (102.2°F) with or without chills Begins in hours and may subside over a few days or up to three weeks.
- Untreated, attacks will be more frequent and more severe.
- NSAIDs: for pain relief and also anti-inflammatory action as these drugs inhibit cyclooxygenase (COX), the enzyme responsible for conversion of arachidonic acid into the prostaglandin pro-inflammatory cytokine family.
- Corticosteroids: steroidal anti-inflammatories provide dramatic symptom relief in acute attack; best for patients who cannot take NSAIDs. Avoid aspirin as salicylates may exacerbate the condition.
- Colchicine: used to decrease uric acid levels. 0.5 to 0.6 mg orally every hour until pain is relieved or nausea or diarrhoea appears, then stop drug; usual total dose, 4 to 8 mg. Generally only effective for 24 to 48 hours, there may be many side effects. GI symptoms may be avoided by IV administration of initial dose, although severe toxicity limits usefulness of IV colchicine. Can also be used to prevent future attacks.
- Uricosuric agents: to reduce serum uric acid levels; e.g., probenecid (250 mg bid for one week, increased to 500 mg bid). Hypersensitivity is indicated by fever and rash (5% of cases) or GI complaints (10%).
- Allopurinol: to reduce serum uric acid levels; 100 mg daily for one week, increased as needed; normal levels often obtained with 200 to 300 mg daily. Use cautiously in renal insufficiency; do not use in asymptomatic hyperuricemia (may precipitate attack).