Gouty arthritis

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Abstract: gouty arthritis is caused by purine metabolic disorder and increased serum uric acid. Human uric acid is derived from the cataboli


Abstract: gouty arthritis is caused by purine metabolic disorder and increased serum uric acid. Human uric acid is derived from the catabolism of nucleic acids and other purine compounds and the breakdown of purine in food. Increased uric acid production and reduced excretion of uric acid can produce uric acid accumulation. Urate deposition in the joints, joints surrounding tissue and subcutaneous tissue caused by arthritis, recurrent, acute red, swollen, pain, gradually produce bone and joint destruction and joint surgery center of Nanfang Hospital of Southern Medical University Shi Zhanjun.

Clinical manifestation:

1, primary gout occurs in men over the age of 40, women are rare, accounting for about 5%. Some patients have family history. 2 asymptomatic period, only high uric acid. Increased blood uric acid to the onset of joint symptoms up to several years. 3 acute stage: often at night suddenly attack, first occurs in the first metatarsophalangeal joint pain, in a few hours of peak, obvious swelling, redness, tenderness, dysfunction. Can be accompanied by fever, up to 38 - 39 C. Fatigue, anorexia, headache and other symptoms. After 1 to 2 weeks, the symptoms were relieved and the patients were followed up for several months to several years. Other joint toe, thumb, metacarpophalangeal joint, ankle, wrist, knee, shoulder, etc. can also occur. Drinking, overeating, fatigue, trauma or mental stimulation can induce arthritis attack. 4 chronic arthritis: frequent attacks of arthritis, intermittent period shorter, joint swelling, joint bone destruction and deformed hyperplasia. Gouty stone in the auricle or joint. Located in the subcutaneous, pale yellow nodules. Ishiba can break out of gout lime material, sinus healing, secondary pyogenic infection. About 10 - 20% of patients with uric acid stones, and can cause hematuria, renal colic symptoms. High blood pressure, coronary heart disease and other complications.

Diagnosis basis:

1, often born in men over the age of 40, women accounted for only about 5%. Major violations of the surrounding joints, repeated attacks. The first attack was the first metatarsophalangeal joint, ankle and tarsal, then in the hand joints etc..

2, joint pain often sudden attack at night, joint swelling, skin temperature, pain, tenderness and movement disorders, high temperature. After a few days to reduce symptoms, into the intermittent period, the normal function of the joints.

In late 3, auricle, near the olecranon and joint involvement, visible to different size tophi, white crystalline salt of uric acid Pokui outflow calciform.

4, laboratory examination: elevated serum uric acid (normal male was 6 mg%, female was 5 mg%). Acute exacerbation may have increased leukocyte, ESR, chalkstone urate crystals visible puncture.

5, the X-ray examination can help early diagnosis: swelling of the joint, and punched out defect or a semicircular edge sharp bone end. Late joint space narrowing, edge joint bone hyperplasia, ankylosis, can be associated with dislocation and pathological fracture.

Treatment principle:

1, acute exacerbation, bed rest, local cold compress. Preventing or reducing the deposition of uric acid into tissues. Avoid alcohol, especially beer. Do not eat food with high purine content, such as liver, kidney, brain, liver extract, vitamin B12 and banned sulfa drugs. Drink more water, taking basic drugs in urine alkalization with ethacrynic acid discharge.

2, the use of colchicine to control the acute exacerbation of symptoms, also used hormone, phenylbutazone, indomethacin and other symptoms.

3, the use of uric acid growth inhibitor (renal dysfunction) or uric acid excretion agent to control high uric acid.

4, the effect of joint function of tophi, or large tophi may rupture, or chalkstone ulceration, feasible surgical treatment of sinus tract. Before and after surgery with colchicine and hormones to prevent acute attack.

Medication principle:

The most effective 1, acute exacerbation of choice, colchicine, 6-12 hours can reduce the symptoms after treatment, but toxic, and can reduce blood uric acid, also cannot prevent the formation and development of gout. Nausea and vomiting, diarrhea and other side effects. Medication should be discontinued when symptoms or side effects occur. With gastrointestinal symptoms can be added atropine.

2, single application of phenylbutazone or non steroidal drugs such as indomethacin, about 3-5 days of seizures. Also with colchicine, 2mg every day, 3 times a day, and even served 2 days to a few days, the general good effect, no adverse reaction.

3, ACTH, prednisone or prednisolone and dexamethasone can control the symptoms, but not long-term use.

4, acute attack control, the blood uric acid is higher than 8mg%, have gout stone, and frequent attack, can take the uric acid preparation, such as the.

5, with urinary calculi and renal insufficiency, probenecid cannot use available xanthine oxidase inhibitors. Hydroxy pyrimidine.

6, in order to improve the solubility of uric acid in the urine, to prevent the formation of stones, given basic medicine soda, 5-6g.

Supplementary Examination:

1, to detect the concentration of uric acid: male 420mmol/L, female blood uric acid > > 360mmol/L has diagnostic value; 2, acute exacerbation has increased leukocyte, erythrocyte sedimentation rate; chronic gout stone, general basic examination combined with clinical manifestations can be diagnosed. 3, some patients may have renal dysfunction or gout complicated with renal damage, and hypertension, arteriosclerosis, coronary heart disease, etc..

Efficacy evaluation:

1 cure: clinical symptoms disappeared, blood and urine uric acid content of normal, normal renal function, continuous follow-up for more than 2 years without recurrence. Joint deformity correction, wound healing, no complications.

2 improvement: in the case of medication, symptoms relieved; uric acid content in blood and urine was close to normal, renal function improved.

3 invalid: clinical symptoms and signs still exist.

Operation indication:

Knee and ankle joint recurrent gouty arthritis, intra-articular uric acid crystallization (gout), although the concentration of blood uric acid to restore normal articular cavity but uric acid concentration is still high, feasible arthroscopic surgery of articular cavity flushing tophi, promote the improvement of symptoms.


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