a systematic disease

1. Gouty Arthritis
By: Honei Belle P. Dela Cruz

2. Gouty Arthritis
 A systemic disease caused by deposition of uric acid
crystals in the joint and body tissues.
 Causes
 Primary Gout – disorder of Purine metabolism.
 Secondary Gout – excessive uric acid in the blood like leukaemia.

3.  Clinical Manifestations
 Severe pain in the involved joints, initially the big toe.
 Swelling and inflammation of the joint.
 TOPHI – yellowish whitish, irregular deposits in the skin that break
open and reveal a gritty appearance associated with inflammatory
episodes.
 PODAGRA
 Fever, malaise
 Body weakness and head ache
 Renal stones due to uric acid deposits

4.  Common sites
o Smaller joints:
• First metatarsophalyngeal joints
• Interphalyngeal joints of foot
• Interphalyngeal joints of the hands
• Knee joint
• Elbow joint

5.  Clinical Manifestations

8.  Diagnostic Procedures
 Arthrocentesis:
 Polarising Microscopy showing Monosodium urate (MSU) : needle-shaped
negatively birefringent either free floating or within neutrophils &
macrophages.
 Joint Fluid analysis:
 Acute gout
 Inflammatory (>2000 cells/ml);
 Monosodium urate (MSU) crystals do not exclude the possibility of septic
arthritis, for this reason it is also recommended to request a Gram
smear

9.  Serum Uric Acid:
 Normal
o = 4.0 to 8.6 mg/dl in men
o = 3.0 to 5.9 mg/dl in women.
 Urinary levels are normal below 750 mg/ 24hrs.
 Urinary levels above 750 mg/dl in 24h in gout > 1100 mg/dl in asymptomatic
hyperuricemia (indicates urate overproduction.)
 24hrs urine collection for uric acid determination :
o Assessing the risk of renal stones and planning for therapy.
(uric acid stones=nephrolithiasis)

11.  Medical Management
 Colchicine (oral parental) an NSAID such as indomethacin, or a corticosteroid
is prescribed to relieve an acute attack of gout.
 Hyperuricemia, tophi, joint destruction, and renal problems are treated after
the acute inflammatory process has subsided.
 Uricosuric agents, such as probenecid, correct hyperuricemia and dissolve
deposited urate.
 Allopurinol is effective when renal insufficiency or renal calculi are a risk.
 Corticosteroids may be used in pt’s who have no response to other theraphy.
 Prophylactic treatment consider if pt experiences several acute episodes or
there is evidence of tophi formation.

12.  Nursing Management
 Provide a diet with low purine
 Avoid Organ meats, aged and process foods
 Strict dietary restriction is NOT necessary
 Encourage an increased fluid intake (2-3L/day) to prevent stone formation
 Instruct the client to avoid alcohol intake
 Provide alkaline ash die to increased urinary level
 Provide bed rest during early attack of gout
 Position the affected extremity in mild flexion
 Administer anti-gout medication and analgesics