What is chronic gouty arthritis, and how should it be managed?
Mar 28, 2023
Source: Cainiu Health
Dr. Xu Shuai
Introduction
Chronic gouty arthritis refers to aseptic inflammation caused by purine metabolism disorders, leading to the deposition of urate crystals in joints and surrounding tissues. It may be triggered by excessive purine intake, defects in purine metabolism, renal dysfunction, decreased glomerular filtration rate, or drug side effects. Management options include general treatment, pharmacological therapy, surgical intervention, physical therapy, and rehabilitation exercises.
Chronic gouty arthritis refers to aseptic inflammation caused by the deposition of urate crystals in joints and surrounding tissues due to disordered purine metabolism. It may be triggered by excessive purine intake, defective purine metabolism, kidney dysfunction, decreased glomerular filtration rate, or drug side effects. The condition can be improved through general management, medication, surgery, physical therapy, and rehabilitation exercises.
1. Causes
1. Excessive Purine Intake
Long-term consumption of high-purine foods such as fatty meats and seafood can increase uric acid production in the body, triggering gouty arthritis.
2. Defective Purine Metabolism
Abnormal purine metabolism leads to increased uric acid production, resulting in elevated blood uric acid levels and subsequent deposition in joint soft tissues, causing disease.
3. Kidney Dysfunction
Patients with impaired kidney function have reduced ability to process and excrete uric acid compared to healthy individuals, leading to increased uric acid levels.
4. Decreased Glomerular Filtration Rate
A reduced glomerular filtration rate caused by various factors can impair uric acid excretion, thereby increasing serum uric acid levels.
5. Drug Side Effects
Certain medications may cause side effects that increase renal tubular reabsorption of uric acid, leading to elevated uric acid levels and disease onset. Examples include furosemide tablets and sodium salicylate injection.
2. Treatment
1. General Management
It is essential to actively avoid triggering factors—such as high-purine diets and excessive fatigue—to prevent ongoing stimulation that could further elevate uric acid levels and worsen the condition.
2. Medication
Under medical supervision, nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to reduce inflammation and relieve pain. Commonly prescribed medications include diclofenac sodium sustained-release tablets, ibuprofen sustained-release capsules, and indomethacin tablets. Additionally, drugs that inhibit uric acid synthesis may be used to reduce uric acid production and alleviate symptoms. Common options include allopurinol tablets and febuxostat tablets.
3. Surgical Treatment
In severe cases where gout has caused joint impairment or deformity, surgical intervention may be necessary under medical guidance. This involves removing tophi and repairing damaged joints to improve limb function.
4. Physical Therapy
For significant pain symptoms, physical therapy under medical supervision—such as infrared irradiation of the affected area—can help improve blood circulation and reduce inflammation.
5. Rehabilitation Exercises
After surgery, patients should strictly follow medical advice regarding rehabilitation exercises to strengthen muscles and promote recovery.
Patients with chronic gouty arthritis should avoid strenuous exercise, enhance care for affected joints, and actively seek regular medical treatment under professional guidance to facilitate improvement of the condition.
