Gout (Inflammatory Arthritis)

 

Definition

Gout ek type ka inflammatory arthritis hai jisme blood me uric acid level increase ho jata hai (hyperuricemia) aur uric acid ke crystals joints me deposit ho jaate hain. Ye crystals joint tissue ko irritate karte hain jisse pain, redness, swelling aur stiffness hoti hai — mostly big toe (first metatarsophalangeal joint) me.

Epidemiology

● Common in middle-aged men.

● Women me menopause ke baad risk badhta hai.

● Lifestyle-related disease (diet & alcohol important factor).

Causes & Risk Factors

● Hyperuricemia (main cause) — excess uric acid production or decreased excretion.

Risk factors:

● High purine diet (red meat, organ meat, seafood).

● Alcohol (especially beer, wine).

● Obesity, metabolic syndrome.

● Kidney disease (reduced uric acid excretion).

● Certain drugs (diuretics, aspirin, cyclosporine).

● Family history of gout.

Pathophysiology

● Blood me uric acid level badhne par needle-shaped urate crystals joints me deposit hote hain.

● Crystals phagocytosed by WBCs → inflammation process start hota hai.

● Inflammatory mediators release → severe pain, redness & swelling.

● Repeated attacks → chronic tophaceous gout (tophi formation in skin, cartilage, tendons).

Symptoms

● Sudden onset of severe joint pain, often at night.

● Commonly affects big toe, ankle, knee, or wrist.

● Joint hot, red, swollen, & extremely tender (even bedsheet touch causes pain).

● Fever may be present in acute attack.

● Chronic cases → tophi (chalky white deposits) in ear, fingers, or around joints.

Complications

● Chronic gouty arthritis (joint deformity).

● Tophi ulceration.

● Kidney stones (uric acid calculi).

● Chronic kidney disease.

Diagnosis

● Serum uric acid level ↑ (>7 mg/dL).

● Joint aspiration → needle-shaped crystals under microscope (gold standard).

● X-ray: tophi or joint erosions in chronic gout.

● Renal function tests (BUN, creatinine).

Treatment

Acute Attack:

● NSAIDs (Indomethacin, Naproxen) → reduce pain & inflammation.

● Colchicine (for acute attack control).

● Corticosteroids (if NSAIDs contraindicated).

Long-term Management:

● Allopurinol or Febuxostat → reduce uric acid production.

● Probenecid → increase uric acid excretion.

● Avoid alcohol & purine-rich foods.

● Maintain hydration & healthy weight.

Nursing Management

● Monitor pain level & joint swelling.

● Provide cold compress during acute attack.

● Encourage rest & elevate affected limb.

● Educate patient about diet modification (avoid red meat, seafood, alcohol).

● Encourage fluid intake (2–3 liters/day).

● Monitor side effects of anti-gout drugs (rash, GI upset, liver function).

● Support patient emotionally as chronic pain can cause stress.

Prevention

● Maintain healthy weight & diet.

● Limit alcohol, sugar, and purine-rich foods.

● Regular exercise & hydration.

● Adherence to prescribed medications.

Prognosis

● With proper treatment & lifestyle change → good prognosis.

● Untreated gout → joint damage, chronic pain, kidney disease.