Gout and crystal arthritis
What is it?
Gouty arthritis (gout) results from the deposition of uric acid crystals in the joints, which become inflamed and over time undergo destruction of bone and joint tissue.
Other crystal arthritis are calcium pyrophosphate arthropathy (chondrocalcinosis or pseudogout) and hydroxyapatite arthropathy, in which the deposits are due to calcium salts.
Causes and risk factors
Only a minority of people with elevated blood levels of uric acid develop gout. For this reason, people who have never had an attack of gout should not be prescribed medication to reduce uric acid levels, as it may cause undesirable consequences.
Elevated uric acid levels in people who are predisposed to developing gout may be caused by:
- Increased production or decreased renal elimination;
- excessive consumption of substances such as red meat and game, from which uric acid is derived (a rarer cause).
Excess uric acid circulates in the blood (hyperuricemia) and is deposited as crystals in various tissues, including the kidneys (gouty nephropathy) and joints (gouty arthritis). Uric acid is excreted in the urine; if it is present in excessive concentrations, it can lead to stone formation.
The cause of calcium deposition in other crystalline arthritis has not been established.
Which are the symptoms?
This pathology is characterized by very intense and sudden signs, such as:
- rapid swelling;
- pain in the affected joint.
Usually the first joint of the toe (tarsometatarsal joint) is the first to be involved. Other joints may be the wrists, finger joints, knees, or ankles.
If the inflammation is left untreated, it persists for a few days or weeks and then goes away. After the first attack, if the uric acid level in the blood does not decrease, gout often flares up again in the same or other joints. A granulomatous inflammatory reaction (tophus) forms around the deposits of uric acid crystals, which corrodes the bone of the joint (chronic tophus gout).
Arthropathies with calcium crystal deposition cause calcification of periarthritic tissues (calcified periarthritis), calcium deposition in articular cartilage (chondrocalcinosis) and acute arthritis (pseudopodagra).
How is it diagnosed?
How is it treated?
With colchicine, a drug that reduces the influx of inflammatory cells. However, the dosages of colchicine needed to turn off the attack frequently cause diarrhea and other side effects. Therefore, classic anti-inflammatory drugs are preferred.
To prevent further attacks, uric acid levels in the blood must be reduced with drugs that lower its production (such as allopurinol, which, however, can cause even serious side effects) or with drugs that increase its renal excretion. There is no specific treatment for calcium depot arthropathy. Acute episodes are treated with anti-inflammatory drugs.
Where do we treat it?
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