- 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
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