I. Concept
A metabolic disease caused by abnormal purine metabolism. The main manifestations are, elevated blood uric acid, recurrent acute arthritis, common in the first metatarsophalangeal joint, and monosodium urate deposits around the joint.
II. Pathogenesis
Elevated uric acid is the hallmark, but not all gout patients have elevated uric acid; normal human blood uric acid indicators.
Men: 5.75 mg/dl (urban), 5.58 mg/dl (rural); women: 4.67 mg/dl (urban), 4.48 mg/dl (rural); children: 3.5 to 4.0 mg/dl.
When blood uric acid >7.0 mg/dl in men and >6.0 mg/dl in women, there is gout formation.
III. Clinical manifestations
There are four stages.
1. asymptomatic hyperuricemia phase; 2. acute gouty arthritis phase; 3. gout attack interval phase; 4. chronic phase.
The manifestations are.
1. acute gouty arthritis with gout is a common symptom.
2. the first metatarsophalangeal joint is the common joint site of gout (accounting for 75%), followed by the knee joint accounting for 27%.
3. most episodes occur at night, with severe pain and awakening, resembling dislocation-like pain.
4. the affected joints are often red, swollen, hot and painful; similar to venous embolitis and cellulitis.
5. Gout attacks, pain like dislocation pain; sometimes without treatment, it can subside even after 3-7 days, with peeling at the joints, and can recur after months or years of treatment, with increasing symptoms of attacks step by step.
6. asymptomatic in the interstitial phase, with monosodium urate (MSU) in the joint fluid aspiration, by which a clear diagnosis can be made.
7. X-ray examination: there are no abnormal signs in the acute phase, and there may be bone defects, round cysts, osteosclerosis and narrowing of joint space in the chronic phase or exacerbation phase.
IV. Laboratory tests
1. joint fluid detected with MSU.
2. elevated blood uric acid level, but it cannot be used as a basis for diagnosis.
3. MSU morphology is crystalline or needle-shaped.
V. Treatment
1. prevention of reoccurrence and formation of gout stones during the acute phase.
Commonly used colchicine (inhibit PMN) + non-chisel anti-inflammatory drugs (NSAID): colchicine tablets immediately 1.0 mg po st ,2~3 hours later with 0.5 mg po st, stop after there is pain relief or gastrointestinal symptoms appear; or inject colchicine 3 mg iv st, then 1.5 mg iv daily (pay attention to prevent overflow into the vein, and tissue necrosis).
2. NSAIDs are currently preferred for safer methods, with intra-articular injections of steroids (methylprednisolone) in older patients.
3. prevention of gouty arthritis and gout stones: small doses of colchicine 0.5 mg once daily, together with probenecid 0.5 mg twice daily and allopurinol 10 mg twice daily.
4. Diet can help uric acid excretion.