GOUTY ARTHRITIS

Definition
 A heterogeneous group of conditions related to a genetic defect of purine
metabolism and fresulting hyperuricemia

 A metabolic bone disorder in which purine (protein) metabolism is altered

and the by-product, uric acid, accumulates

Also Known As
 Disease Of Kings

Incidence
 Primary gout has 85% incidence of all cases, of which 95% are men

Risk / Predisposing Factors

 Lifestyle factors. Choices you make in your everyday life may increase
your risk of gout. Excessive alcohol use — generally more than two drinks
a day for men and more than one for women — increases the risk of gout.

 Diet. Excessive intake of foods high in purine such as shellfish, organ

meats, red meats, increases uric production in the body

 Medical conditions. Certain diseases and conditions make it more likely

that you'll develop gout. These include untreated high blood pressure
(hypertension) and chronic conditions, such as diabetes, high levels of fat
and cholesterol in the blood (hyperlipidemia), and narrowing of the arteries
(arteriosclerosis).

 Certain medications. The use of thiazide diuretics — commonly used to

treat hypertension — and low-dose aspirin also can increase uric acid
levels. So can the use of anti-rejection drugs prescribed for people who
have undergone an organ transplant.

 Family history of gout. If other members of your family have had gout,
you're more likely to develop the disease.

 Age and sex. Gout occurs more often in men than it does in women,
primarily because women tend to have lower uric acid levels than men do.
After menopause, however, women's uric acid levels approach those of
men. Men also are more likely to develop gout earlier — usually between
the ages of 40 and 50 — whereas women generally develop signs and
symptoms after menopause.
Manifestation
4 stages
I. Asymptomatic hyperuricemia

II. Acute attack accompanied by redness, swelling, and exquisite tenderness

in one join (toes, fingers, wrist, ankles, knees, or other joints). Great toe is
most common site. First attack develops quickly, often overnight. Fever,
tachycardia, malaise, and anorexia may be noted. Acute episode usually
subsides within 1 week. As edema subsides, pruritus and local
desquamation (tissue loss) may be noted.

III. A period of time between attacks during which affected joint returns to
normal and client may be asymptomatic for years. Eventually, other
attacks occur

IV. Permanent changes in multiple joints with restrictions in movement. Trophi

may be detected on ears, hands, elbows, feet and knees. Atherosclerosis
occurs in about 50% of all clients.

Types / Classification / Stage

 Primary gout is caused by an inherited defect of purine metabolism

 Secondary gout is an acquired condition that occurs following

hematopoietic (multiple myeloma, polycythemia vera, and leukemia) or
renal disorders.

Pathophysiology
 In the body, uric acid is made by enzymatic breakdown of tissue and
dietary purines. Huperuricemia develops because of underexcretion or
overproduction of uric acid. In addition to accumulation in the blood, uric
acid is concentrated in the synovial fluid, myocardium, kidneys, and ears.
When uric acid levels reach a certain level, they crystallize, and the
crystals (trophy) are deposited in connective tissue. Because the crystals
are deposited in connective tissue, gout is classified as a form of arthritis.

Diagnostic
 Joint fluid test. Your doctor may use a needle to draw fluid from your
affected joint. When examined under the microscope, your joint fluid may
reveal urate crystals.

 Blood test. Your doctor may recommend a blood test to measure the uric
acid level in your blood. Blood test results can be misleading, though.
Some people have high uric acid levels, but never experience gout. And
some people have signs and symptoms of gout, but don't have unusual
levels of uric acid in their blood.
Management
 Hyperuricemia, trophi, joint destruction, and renal problems are treated
after the acute inflammatory process has subside.

 Uricosuric agents, such as [rpbemecid, correct hyperuricemia and dissolve

deposited urate.

 Colchicines (oral or parenteral) or a nonsteroidal anti-inflammatory drug

(NSAID), such as indomethacin, is used to relieve acute attack

 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
 Pain related to inflammation, increased disease activity, tissue damage,
fatigue, and lowered tolerance

 Fatigue related to increased disease activity, pain, inadequate rest,

deconditioning, inadequate nutrition, emotional stress, depression

 Impaired physical mobility related to muscle weakness, pain on

movement, lack of or improper use of ambulatory devices

 Self-care deficits (feeding, bathing, dressing, toileting) related to

contractures, fatigue, or loss of motion

 Disturbed sleep pattern related to pain and fatigue

 Disturbed body image related to physical and psychological changes and

dependency imposeb by chronic illness

 Ineffective coping related to actual or perceived lifestyle or role changes

Nursing responsibilities
 Relieving Pain And Discomfort
 Reducing Fatigue
 Increasing Mobility
 Facilitating Self-Care
 Improving Sleep
 Improving Body Image
 Monitoring and Managing Potential Complications
  Increasing Knowledge of Disease Management
 Promoting Home and Community-Based Care
 Health teaching
Illustrations

Reference
Medical Surgical Nursing by Black, 8th ed.
Textbook of Medical Surgical Nursing by Johnson 10th ed.
www.emedicine.com