Chronic gouty arthritis

Alternative names:

gout - chronic; gouty arthritis - chronic

Definition:

A persistent metabolic disease, marked by uric acid deposits in the joints, which causes painful arthritis in many joints, especially of the feet and legs.

Causes, incidence, and risk factors:

Gout is caused by a defect in metabolism that results in an overproduction of uric acid, or a reduced ability of the kidney to eliminate uric acid. The exact cause of the metabolic defect is unknown. The condition may also develop in people with diabetes mellitus, obesity, sickle cell anemia, and kidney disease, or it may follow drug therapy that interferes with uric acid excretion.

Gout has four stages: asymptomatic, acute, intercritical, and chronic. In acute gouty arthritis, there is a sudden onset of symptoms that usually involves only one or a few joints. The pain frequently starts during the night and is often described as throbbing, crushing, or excruciating. The joint appears infected with signs of warmth, redness, and tenderness. The attacks of painful joints may subside in several days, but may recur at irregular intervals. Subsequent attacks usually have a longer duration.

Several attacks of gout may occur each year resulting in chronic joint symptoms such as joint deformity and limitation of motion in the affected joints. Uric acid deposits called tophi develop in cartilage tissue, tendons, and soft tissues. Deposits also can occur within the kidneys, leading to chronic renal failure.

Risk factors include recurrences of acute attacks of gouty arthritis, lack of preventative measures in those with prior attacks, kidney disease, diabetes mellitus, sickle cell anemia, or obesity. Men and postmenopausal women are at higher risk than younger women. The incidence is 2 out of 1,000 people.