What is Acute Gouty Arthropathy & How is it Treated?| Causes, Symptoms, Risk Factors of Acute Gouty Arthropathy

Gouty arthritis is a painful, inflammatory condition, mainly affecting the joints, resulting from the deposition of urate crystals in the joint spaces. It is a common condition that can affect anyone. Here, we will discuss causes, risk factors, symptoms, and treatment of acute gouty arthropathy.

Gout is a metabolic disease, characterized by acute or chronic arthritis, due to the deposition of monosodium urate crystals in the bones, joints, soft tissues, and even the kidneys.¹ It can present itself in the form of acute arthritis or acute gouty arthropathy or chronic arthropathy (tophaceous gout). The main finding of gouty arthropathy is the presence of urate crystals in certain areas of the body and the elevated levels of serum uric acid.

Acute gouty arthritis, is the commonest inflammatory arthritis in the United States affecting about 8.3 million Americans, according to the National Health and Nutrition Examination Survey (NHANES) 2007-2008.²

Gout is diagnosed using the clinical criteria given by the American College of Rheumatology. The diagnosis is confirmed by the identification of monosodium urate crystals in synovial fluid of the affected joint.³

Let us understand acute gouty arthropathy in detail. Here, we will discuss causes, risk factors, symptoms, and treatment of acute gouty arthropathy.

Gout is caused due to accumulation of urate crystals in the joints, which leads to inflammation and results in intense joint pain. This occurs due to excess uric acid in the blood, which when circulating, gets deposited in the joints. An acute inflammatory episode results in an attack of gout, as is acute gouty arthropathy.

Purines, which are naturally found in your body and also obtained from certain food sources are broken down to release uric acid. Usually, uric acid dissolves in the blood and is excreted through the urine, in the form of waste matter. However, sometimes there is an overproduction of uric acid in some people or there can be problems with the metabolism of purine, affecting the excretion of uric acid.⁴

When there is an excess of uric acid in the body, it can build up and form sharp urate crystals, needle-like. The crystals get deposited in the joints, causing inflammation, pain, and stiffness of joints.

Some of the risk factors identified for acute gouty arthropathy include the following,

• Gout usually affects men more than women, however, post-menopausal women have the same risk as men. In men, the risk of acute gouty arthropathy is more during middle ages, whereas, in women, it may affect after menopause.
• Having a diet rich in purine foods such as seafood, organ meats, sweetened drinks, and some alcoholic beverages.
• Having a family history of gout
• Being overweight or obese can increase the risk of metabolic problems and ineffective elimination by the kidneys.
• Medical conditions like metabolic syndrome, diabetes, high blood pressure, or heart diseases, too can increase the risk of gouty arthritis.
• Certain medications, recent surgery, or trauma may raise the risk of an attack of acute gout arthropathy.

The symptoms of acute gouty arthropathy include sudden onset of joint pain, erythema (reddening of the skin), limited range of motion, and inflammation. It mostly affects the great toe, the insteps, ankles, heels, knees, and other joints of the legs.

It is noted that the most commonly involved joint in acute gouty arthropathy is the big toe or the first metatarsophalangeal joint. However, it may attack any joint and maybe more than one joint at once. An acute gouty arthropathy attack may reach its peak about 12 to 24 hours after its onset and then gradually begins to reduce in its severity. It can begin resolving on its own even without treatment in most cases. Further, recovery may be expected without treatment, within the next 7 to 14 days.⁵

Acute gouty arthropathy can also involve the spinal column in some cases, resulting in back pain. Tophaceous gout that involves the spinal cord is one of the causes of myelopathy and frank cord compression. It is also noted that hypertension, diabetes, and atherosclerosis disease are risk factors of gout and hyperuricemia, which are a characteristic feature of acute gouty arthropathy.⁶

Acute gouty arthropathy may appear as a flare-up, which is followed by a period of remission, which is an asymptomatic period lasting for several months to years.²

An acute episode of joint inflammation, pain, and swelling often recommends the use of blood tests, imaging studies, and fluid aspiration from the swollen joint. These also help to rule out other possible causes of joint inflammation like infections, or other causes of arthritis. Diagnosis of acute gouty arthropathy can be made by detecting urate crystals in the aspirated synovial fluid from the affected joint. High levels of uric acid in the blood support the finding.

Acute gouty arthropathy must be attended with proper investigations, treatment, and prevention strategies. Although many cases, acute attacks may resolve on their own, medical evaluation helps plan further courses of action and prevent complications.

Some of the common complications of acute gouty arthropathy include

Recurrent Episodes – Some people may never experience repeated episodes while some may have frequent or recurrent attacks after the first one. Timely diagnosis and treatment can help educate the person on lifestyle changes and medications, thus help prevent damage to the joints.

Chronic Tophaceous Gout – If acute gouty arthropathy is left untreated, the condition can advance into a chronic problem. The deposition of urate crystals may continue in various joints, causing advancement and formation of nodules or tophi under the skin. Tophi can get swollen during a flare-up and cause pain in the joint area.

Renal Stones – With excess uric acid, urate crystals may also be formed in the kidneys and the urinary tract, which can lead to renal stones.

Treatment of acute gouty arthropathy aims at controlling the symptoms, reducing pain, limiting the recurrence of attacks, reducing the risk of complications, controlling the number of tophi in chronic cases, and reducing or preventing joint destruction.

The acute attacks of gouty arthropathy are treated with non-steroidal anti-inflammatory (NSAIDs), corticosteroids, and colchicine. Some other drugs may also be prescribed depending on the severity of the condition. In some cases, where these medicines cannot be used or based on the severity, steroid injections or intra-articular steroids may be considered. Combination therapy may be planned depending on the condition.

Doctors may also use some medications to prevent complications of gout. These medications aim at blocking uric acid production and improving the removal of uric acid from the body.

While almost all people having acute gouty arthropathy have elevated uric acid levels, not all people with high uric acid have gout. It is noted that some people may have high uric acid levels but no show symptoms of gouty arthropathy. In most cases, people may have high uric acid levels for many years before having an attack of acute gouty arthropathy – this period is termed as asymptomatic hyperuricemia. While there is no treatment recommended during this period, elevated uric acid levels can be considered as a risk factor for gouty arthropathy and necessary preventive action can be taken. The risk of having gout increases with increasing levels of uric acid in the blood, however, some people may never experience acute gouty arthropathy at all.

Prevention of acute gouty arthropathy can be achieved by following some of the following lifestyle measures.

• Maintain an ideal weight. Losing even a few pounds can help the joints and improve metabolism.
• Drink plenty of fluids, particularly, water to flush out the body waste. Avoid sugary and alcoholic beverages.
• Include low-fat dairy as a source of protein
• Limit the intake of fish, seafood, red meat, and organ meat, as they are rich in purine, which can trigger a gout attack.

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