Alternative Names: Gout - chronic; Gouty arthritis - chronic

Causes, incidence, and risk factors:

Gout is caused by an overproduction of uric acid or a reduced ability of the kidney to get rid of uric acid. The exact cause is unknown. It is more common in males, postmenopausal women, and people with high blood pressure. Heavy alcohol use, diabetes, obesity, sickle cell anemia, and kidney disease also increase the risk.

The condition may also develop in people who take drugs�that interfere with uric acid excretion.

Symptoms:

• An attack of chronic gout is similar to an attack of acute gouty arthritis. The symptoms come on suddenly, usually involving only one or a few joints. The pain frequently starts during the night and is often described as throbbing, crushing, or excruciating. The affected joints show signs of warmth, redness, and tenderness. The pain tends to subside within several days. Chronic gout attacks, however, occur more often.
• If several attacks of gout occur each year, this may cause joint deformity and limited motion in affected joints. Uric acid deposits called tophi develop in cartilage tissue, tendons, and soft tissues. These tophi usually develop only after a patient has suffered from the disease for many years. Deposits also can occur in the kidneys, leading to chronic kidney failure.

Signs and tests:

There may be a current or previous medical history of acute arthritis in one joint. A physical examination of joints shows arthritis and tophi.

Tests that indicate gouty arthritis include:

• Synovial (joint) fluid analysis that detects uric acid crystals
• Elevated uric acid level
• Joint x-rays which show damage consistent with gouty arthritis

Treatment:

Chronic gouty arthritis is treated with drugs like probenecid or sulfinpyrazone, which reduce uric acid levels. Another approach is to use allopurinol, which blocks the enzyme that produces uric acid. Patients should drink plenty of water or other fluids to reduce the risk of kidney complications.

Colchicine can be added to prevent further acute attacks. This drug can be discontinued when uric acid levels are stable (usually after 3 months), but it can also be continued at low doses to help prevent further attacks.

Support Groups:

For additional information and resources, see arthritis resources.

Expectations (prognosis):

Symptoms are generally worse in people who develop the disease before age 30.

Complications:

• Kidney stones
• Kidney failure
• Joint deformities
• Loss of mobility (patient becomes bedridden), rare

Calling your health care provider:

Call your health care provider if symptoms of chronic gouty arthritis develop.

Prevention:

Drugs that lower the serum uric acid concentration may prevent the development of chronic gouty arthritis in susceptible people.