Definition
- Gouty arthritis is a metabolic disease marked by urate crystal deposits in the joints throughout the body, causing local irritation and inflammatory responses.
- inflammatory disease of the joints
- mostly affects feet, great toe, ankle & midfoot
- 19 times more common in men
- peak icidence between 20 – 40 years old
- Chronic Polyarticular Gout – final, unremitting stage of the disease marked by persistent, painful polyarthritis
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Causes
- Decreased renal excretion of uric acid
- Genetic defect in purine metabolism
- Hereditary factors
- Oversecretion of uric acid
- Radical dieting practices that involve starvation
- Secondary gout associated with drugs
- Secondary gout associated with other diseases:
- Diabetes Mellitus
- Hypertension
- Leukemia
- Myeloma
- Obesity
- Polycythemia
- Renal disease
- Sickle Cell Anemia
Pathophysiology
- Gout is characterized by formation of tophus deposits in soft tissues and urate crystals in joint synovia. It primarily affects joints in the feet (especially the great toe) and legs, but it may strike in any joint.
- The disorder follows a variable course of periodic attacks, often with long symptom-free periods between attacks. Eventually, it can lead to chronic disability and in some cases, severe hypertension and progressive renal failure.
Assessment/Clinical Manifestations/Signs And Symptoms
- Sudden attacks, usually at night, with periodic remissions and exacerbations.
- Pain, acute, crushing and pulsating
- Joint edema and inflammation
- Intolerance to the weight of bed linens over the affected joint
- Pruritus or skin ulceration over the affected joint
- Signs of renal involvement (e.g. oliguria, low back pain, hypertension) in severe disease
Laboratory and diagnostic study findings
- Arthrocentesis reveals urate crystals in synovial fluid
- Serum uric acid level is increased
- Radiograph may show joint damage in advanced disease
Complications
- Renal Calculi
- Atherosclerotic disease
- Cardiovascular lesions
- Stroke
- Coronary Thrombosis
- Hypertension
- Infection with tophi rupture
Medical Management
- Hyperuricemia, tophi, joint destruction and renal problems are treated after the acute inflammatory process has subsided.
- Uricosuric agents, such as probenecid, correct hyperuricemia and dissolve deposited urate
- Colchicine (oral or parenteral) or a NSAIDs, such as indomethacin is used to relieve acute attacks
- Allopurinol is effective, but use is limited because of the risk of toxicity
- Aspiration and intra-articular corticosteroids are used to treat large-joint acute attacks
Nursing Diagnosis
- Acute pain
- Chronic pain
- Impaired physical mobility
- Activity intolerance
- Bathing/hygiene self-care deficit
Nursing Management
- Promote measures to prevent exacerbations
- Urge the client to drink 2 to 3 L of fluid daily and to report any decrease in urine output.
- Teach the client about dietary modifications to limit foods high in purine (e.g. organ meats, anchovies, sardines, shellfish, chocolate, meat extracts).
- Provide measure to promote comfort and reduce pain.
- Maintain strict bed rest for 24 hours after an attack.
- Provide a bed cradle to keep bed linen off affected joints to help reduce pain.
- Administer prescribed medications, which may include nonsteroidal anti-inflammatory drugs, uric acid synthesis inhibitors, and uricosuric agents.
- Colchicine may be prescribed for acute attack and used in small doses for prevention.
- Nausea, vomiting, and diarrhea are toxic effects of colchicines and should be reported to the health care provider.
