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Acute Gouty Arthritis
Arthritis refers to inflammation and irritation of the joint space. Gout is a form of arthritis that results from the body's production of uric acid crystals within the joint space. These crystals cause a cycle of irritation and inflammation in the joint. Gout can be hereditary and is also seen in patients with elevated uric acid in the bloodstream (everyone has some uric acid). Gout is more rare in females than in males. Common symptoms include a hot, painful, swollen joint that the patient refuses to move. This form of arthritis can be confused with septic arthritis. This is based on the similarity of their symptoms. The most commonly affected joint in gout is the "big toe" joint (or the knee). It is often through the characteristic location of the pain that these two forms of arthritis can be distinguished. Evaluation will include history and physical examination. Diagnosis may need to be confirmed by arthrocentesis or aspiration of fluid removed from joint space with a needle. Microscopic analysis of this fluid can reveal the crystals characteristic of gout. Blood tests to check the uric acid level may also be performed. Treatment is directed at decreasing the body's excess uric acid by using special medications (Allopurinol). This can help reduce the incidence of future attacks. In the case of an acutely swollen and tender joint, anti-inflammatories (i.e. aspirin, ibuprofen) and colchicine are given to reduce pain and swelling. Joint rest (avoid use), elevation of the joint, and in some cases splinting may also help. Certain rich foods (cheese and wines) can increase gouty attacks. Some medications (aspirin) can also increase the risk of gouty arthritis. Avoiding alcohol can reduce the incidence of gouty attacks in some patients. Discuss the above treatments with your physician. The Rheumatologist is the expert in the treatment of this problem.
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