Gouty Arthritis

• Type of arthritis that causes inflammation usually in one joint.
• Disorder of purine metabolism
• Characterized by high levels of uric acid in the blood and in the urine.
• There is precipitation of urate crystals (tophi) in the joints. This causes inflammation and pain.
• Occurs most often in males.

Causes

• Too much uric acid in the blood (hyperurucemia).
• Severe dieting or starvation
• Regular use of aspirin, niacin or diuretics
• Heavy use of alcohol especially beer
• Family history of gout
• Very low calorie diet
• Obesity
• Frequent episodes of dehydration
• Recent surgery or trauma.

 Clinical Manifestations

• Joint pain, redness, heat and swelling. Big toe and ankle are most commonly affected.
• Peeling and itching of the skin around the affected joint.
• Headache
• Limited movement in the affected joint.
• Malaise
• Tachycardia. 

 Diagnostic Methods

• Arthrocentesis
• Blood testing - uric acid determination

  
Medical Interventions

• Aspiration and intra-articular corticosteroids are used to treat large-joint acute attacks.
• Acute attack - Colchicine (discontinue if diarrhea or nausea and vomiting occur)
• Use ice to reduce swelling
• Prevention - uricosuric agents. Increases excretion of uric acid in the urine.
• Benemid (Probenecid)
• Anturane (Sulfinpyrazone)
• Zyloprim (Allopurinol) - inhibits uric acid formation. 

Nursing Interventions

• Anti-gout medications should be used cautiously in client with gastrointestinal, renal, cardiac or hepatic diseases.
• Maintain a fluid intake of at least 2 to 3 liters a day to avoid kidney stones.
• Instruct client to avoid alcohol and caffeine. These products can increase uric acid levels.
• Avoid purine rich foods. (organ meats, shellfish, legumes, sardines mushrooms, beer/wine)
• Instruct patients to take medications with food to prevent gastrointestinal irritation.
• Instruct patient to avoid large dose of vitamin C while taking Allopurinol to prevent kidney stones.
• Advise patient to have a yearly eye examination. Visual changes can occur from prolonged used of Allopurinol.
• Do not take Aspirin with anti-gout medications to prevent gout attack.
• Allopurinol may increase the effect of Coumadin and oral hypoglycemic agents.
• Observe for the following side effects of anti-gout medications.
• Headache
• Nausea, vomiting and diarrhea
• Bone Marrow depression
• Flushed skin and skin rash
• Uric acid kidney stone
• Sore gums
• Metallic taste