Gout Gouty Arthritis

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GoutGouty Arthritis

• By Mike Parenteau

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Etiology/Pathophysiology

• Gout is a metabolic disease resulting from an
  accumulation of uric acid in the blood
• It is an acute inflammatory condition associated
  with infective metabolism of purines.
• Gout can be primary , secondary, or idiopathic.
• It affects men aproximately times more than women

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PurineA side note

• Purine is an organic compound commonly found in
  the body and is metabolized by the body into uric
  acid. People with primary gout have either an
  increased production of uric acid or an impaired
  excretion of uric acid, or a combination of both.

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Etiology/Pathophysiology

• In this condition sodium urate crystals are
  deposited on the articular cartilage of joints
  and in the particular tissue like tendons. This
  provokes an inflammatory reaction of these
  tissues. These deposits often increase in size
  and burst through the skin to form sinuses
  discharging a chalky white material.

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Etiology/Pathophysiology

• Normally, the human bloodstream only carries
  small amounts of uric acid. However, if the blood
  has an elevated concentration of uric acid, uric
  acid crystals are deposited in the cartilage and
  tissue surrounding joints. Elevated blood levels
  of uric acid can also result in uric kidney
  stones.

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Etiology/Pathophysiology

• Of all people with gout, 85 have a genetic
  tendency to develop the disease.
• Tophi (uric acid crystal deposits ) result in
  inflammation of the joint it is unclear why this
  occurs.
• Typically the big toes are involved, but other
  joints can be affected

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Clinical Manifestations

• Onset occurs at night, with excruciating pain,
  edema, and inflammation in the affected joint.
• The pain may be of short duration, or may be
  saver and continuous for 5 to 10 days.
• The patient may have repeated attacks or only one
  attack in a life time.
• Tophi are seen around the rim of the ear and can
  disfigure the ear. Surgical removal may be needed

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Assessment/ Subjective

• Noting a complaint of pain occurring at night
  involving the big toe.
• Dietary history, with specific questions
  regarding alcohol and foods high in purine such
  as organ meats

                       
   MMMM PIG Organs Its what's for
dinner                      
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Assessment/Subjective

• Assessment of joints for signs of edema, heat,
  discoloration, and limited movement
• Vital sign data may reveal an elevated
  temperature and hypertension, tachycardia, and
  tachypnea
• Tophi can form in the kidneys causing impaired
  function.

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Diagnostic tests.

• Serum and urinary uricacid levels
• C.B.C.
• Elevated E.S.R.(Erthrocyte sedimentation rate)
• X- Ray revel cysts and toe bone pockets.
• Synovial fluid will contain urate crystals

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Medical management

• Acutely, first line treatment should be pain
  relief. Once the diagnosis has been confirmed,
  the drugs of choice are indomethacin, other
  nonsteroidal anti-inflammatory drugs (NSAIDs), or
  intra-articular glucocorticoids, administered via
  a joint injection.

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Medical management

• Colchicine was previously the drug of choice in
  acute attacks of gout. It impairs the motility of
  granulocytes and can prevent the inflammatory
  phenomena that initiate an attack of gout.
  Colchicine should be taken within the first 12
  hours of the attack and usually relieves the pain
  within 48 hours. Its main side-effects
  (gastrointestinal upset) can complicate its use.
  NSAIDs are the preferred form of analgesia for
  patients with gout.

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Nursing Intervetions

• Interventions are aimed at giving medications
  prescribed by the physician for relief of pain
  and inflammation
• When giving colochicine it is important to
  observe for side effects, such as diarrhea,
  nausea, and vomiting.
• Increase fluid intake
• Careful documantation of I and O.

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Nursing Intervetions

• Bed rest
• Joint immobilization
• Pt teaching is aimed at giving info about the
  disease and stressing the importance of keeping
  uric acid levels within normal limits