gouty arthritis
Introduction
Introduction to gouty arthritis Gouty arthritis is caused by deposition of urate in joint capsules, bursae, cartilage, bone and other tissues. It has many genetic and family factors, which occur in people over 40 years old. Men, more common in the metatarsophalangeal joints of the big toe, can also occur in other large joints, especially the ankle and foot joints. Mainly manifested as severe pain in the joints, often unilateral sudden occurrence. The tissue around the joint has obvious swelling, fever, redness and tenderness. Blood uric acid examination can confirm the diagnosis, and the application of drug treatment has a good effect. basic knowledge The proportion of sickness: 0.01% Susceptible people: no specific population Mode of infection: non-infectious Complications: bursitis
Cause
Causes of gouty arthritis
High uric acid (30%):
High uric acid, uric acid is the final product of Purine metabolism. Gout is a long-term metabolic disorder caused by increased blood uric acid. If the blood uric acid concentration is higher than this saturation point for a long time, it is medically called "hyperuricemia."
Drinking (30%):
Drinking alcohol is easy to cause gout, because alcohol in the liver tissue metabolism, a large amount of water, so that the blood concentration is strengthened, so that the uric acid that is already close to saturation, accelerate into the soft tissue to form crystallization, resulting in excessive reaction (sensitivity) of the body's immune system Inflammation.
Other (25%):
Gout can be caused by diet, weather changes such as sudden changes in temperature and pressure, and trauma. Family tendencies, genetic patterns are still unclear.
Pathogenesis
Regarding the pathogenesis of gouty arthritis, many scholars generally believe that it is related to polymorphonuclear leukocytes. The sodium urate crystals released by synovial tissue and articular cartilage during gout are phagocytized by white blood cells of joint fluid, and the destruction of white blood cells releases protease and inflammatory factors. Into the synovial fluid, the enzyme inflammatory factor increases the white blood cells in the joint, so more white blood cells that phagocytize the urate crystals successively rupture to release enzymes and inflammatory components, forming a vicious circle that further leads to acute synovitis and articular cartilage. Destruction, the concentration of uric acid in the tissue is very low, especially when the pH of the body fluid is low. When the blood uric acid concentration exceeds 80 mg/L, there is urate deposition. The common sites are joint capsule, cartilage and osteoporosis. It can also be seen in the kidney and subcutaneous connective tissue. If there is too much local accumulation, it will form tophi.
Prevention
Gouty arthritis prevention
Although high blood uric acid is not the direct cause of gouty arthritis, its presence can cause recurrence of gout, so early diagnosis of asymptomatic hyperuricemia should be made, and drugs that promote uric acid excretion or inhibit uric acid production should be used in time. To restore normal uric acid, this is the key to the prevention of this disease, specific measures are:
1, do not enter the sorghum diet, such as the animal's heart, liver and kidney and brain, to avoid the fat and greasy taste, overweight people must limit alcohol consumption when drinking alcohol or alcohol.
2, exercise properly, enhance the ability to resist disease, avoid fatigue and maintain a comfortable mood, and eliminate tension in time.
3, acute patients should rest in bed, raise the affected limbs, local fixed cold after 24 hours can be hot, pay attention to avoid cold and warm, should drink plenty of water to quickly stop acute attacks.
4, men with a family history of gout should always check blood uric acid, if suspicious, that is, given preventive treatment.
5, in order to prevent recurrence, long-term use of small doses of colchicine, you can also take a small dose of probenecid.
6, if there are hypertension, nephritis, kidney stones and other complications should be appropriate treatment.
7, local ulceration, can be treated according to general surgery.
Complication
Gouty arthritis complications Complications bursitis
The common complications of this disease are pain and disability. Gouty arthritis can be stiff due to joint destruction and loss of function.
Symptom
Symptoms of gouty arthritis Common symptoms Uric acid in the joints... Itching toe gout tension refers to root pain, blood, soreness, severe pain, cold war, joint swelling and pain
The typical first-episode gouty arthritis is mostly monoarthritis, with the first metatarsal toe and the big toe joint being more common, followed by the ankle, knee, elbow, wrist, hand and other joints of the foot. , often sudden at night, can wake up because of pain and can not fall asleep all night, recurrent episodes, can develop polyarthritis, or migratory arthritis, affected joint red, swollen, hot, pain, limited activity, When the joints are affected, there is often exudate, which may be accompanied by fever, chills, fatigue, anorexia, headache and other symptoms. Generally, the symptoms are relieved after 1-2 weeks. The local skin redness and swelling turn brownish red and gradually return to normal, sometimes there may be scaling and Itching, chronic sodium sulphate gradually increased in the joints, the episodes gradually increased, the intermittent period shortened, the affected joints increased, the pain increased, the inflammation could not completely subside, the tophi was appeared, the tophi was more common in the joints and kidneys, and the outer ear was Toe, toe, interphalangeal and metacarpophalangeal joints will also appear tophi, with the continuous deposition of windshield, resulting in joint hypertrophy, deformity, stiffness, limited mobility.
The onset of the disease can involve two or three joints including the first metatarsophalangeal joint. The first metatarsophalangeal joint lesion accounts for about 50% of the gout patients. It is a multiple joint of the disease, sputum, ankle, knee, elbow and wrist. It can also be seen that in recent years, due to the development of anti-cancer treatment, secondary gout has an increasing trend. Primary gout is found in men over 40 years old, women are few and mostly menopausal women, usually divided into 4 phases:
(A) asymptomatic period : longer time, only blood uric acid increased, about 1/3 of patients have joint symptoms.
(B) acute arthritis: more sudden onset at night, severe joint pain, the first joint often involving the big toe joint, followed by sputum, knee, etc., joint red, swollen, heat and tenderness, general weakness, fever, headache, etc. It can last for 3 to 11 days, drinking, overeating, overwork and cold, surgical stimulation, and mental stress can be the cause of seizures.
(3) Intermittent period: for several months or years, the interval between recurrent episodes becomes shorter, the disease period is prolonged, the lesions and joints increase, and gradually become chronic arthritis.
(4) Chronic arthritis period : from acute onset to chronic arthritis, the average age is about 11 years, the joints appear stiff and deformed, and exercise is limited. About 30% of patients can see tophi and kidney complications and ureteral stones, etc. Hypertension, renal cerebral arteriosclerosis, myocardial infarction, a small number of patients died of renal failure and cardiovascular accidents, secondary gout course is similar, secondary to blood diseases, intermittent interval of glycogen storage disease, increased blood uric acid test Up to 20mg% (normal: male 7mg%, female 6mg%), polarized light microscopy found in the synovial fluid phagocytized by urate crystal white blood cells, white blood cells increased in the acute phase, erythrocyte sedimentation rate accelerated, X-ray examination showed subchondral bone The wear and tear damage and local osteoporosis, corrosion or cortical fracture, joint space stenosis and marginal bone hyperplasia, gout stones can be calcified shadows.
The intermittent period of the disease can last for several months or several years, but as the condition worsens, the intermittent period can be shorter and shorter. The corn granules can be seen under the ear, earlobe and joint skin, which can be due to alcoholism, overeating, and overtime. Induced by labor or mental stress, some patients can be converted to chronic, and severe joints are stiff due to destruction.
Examine
Gouty arthritis examination
1. The blood urate concentration is increased, the normal value is 70mg/L for males, 60mg/L for females, and higher than 180mg/L for higher ones. The blood cell sedimentation rate is fast and the NPN is increased during the attack period; joint liquid microscopic examination There is urate crystals.
2. X-ray plain film: early joint swelling, late worm-like or chisel-shaped defect at the proximal end of the joint, late joint space stenosis, severe bone destruction, soft tissue swelling, calcification in tortoise calcification Shadow.
3. CT and MRI examination: It is helpful for the early diagnosis of this disease, and can be used as appropriate.
4. Some patients may have renal dysfunction or gout complicated by renal dysfunction and complicated hypertension, arteriosclerosis, coronary heart disease, so it is necessary to check the optional examination program as appropriate.
Diagnosis
Diagnosis and diagnosis of gouty arthritis
diagnosis
Clinical manifestations, tests, and X-ray examinations are helpful for diagnosis, but complete diagnosis is made by urate crystals found in synovial membranes or joint fluids, as uric acid content is also elevated in psoriatic arthritis and rheumatoid arthritis.
In the clinical encounter with middle-aged and elderly male obese people, the first metatarsophalangeal joint or ankle joint, the back of the foot and other single joint redness and severe pain, have special effects on colchicine treatment, and the symptoms are relieved in about 1 week, with or without Patients with elevated blood uric acid can be diagnosed with acute gouty arthritis. At present, the diagnostic criteria established by the American College of Rheumatology in 1977 are used at home and abroad:
(1) Acute arthritis attacks more than once, reaching the peak of attack within 1 day.
(2) Acute arthritis is limited to individual joints, the entire joint is dark red, and the first thumb joint is swollen.
(3) Acute exacerbation of unilateral tibial arthritis.
(4) There is a tophi.
(5) hyperuricemia.
(6) Asymmetric joint swelling and pain.
(7) The episode can stop on its own.
Those who have more than 3 of the above conditions and can rule out secondary gout can be diagnosed.
Differential diagnosis
Early misdiagnosis as rheumatoid arthritis, bursitis, septic arthritis, acute cellulitis.
1. Identification with rheumatoid arthritis: more common in women, often invading small joints, no acute symptoms of gout, soft tissue swelling with joints as the center, a fusiform shape, and gout with the bone defect as the center, irregular swelling, bone Destruction is less than gout, and there is general osteoporosis, which is ineffective for colchicine treatment.
2. Identification of acute cellulitis with foot: acute diffuse suppurative inflammation of soft tissue, often history of cold, rarely seen at night; no invasion of joints or joint symptoms; systemic symptoms and chills and white blood cells Increased symptoms; in addition, age is not limited, and will not recur multiple times after treatment.
3. Distinguish points from simple bursitis of the big toe: often have a history of trauma or local chronic irritative stimuli, which are more common in the hallux valgus, the size of the shoe, or the local weight or the weight of the foot; Or the cause is corrected, it is not easy to subside on its own. In addition, the time of attack, the degree of pain is not serious, and it is not effective for colchicine treatment.
4. Others should be differentiated from pseudo-gout: the disease is caused by pyrophosphate metabolism disorder, more common in the elderly, the main part of the invasion is mainly large joints (common knee joints), joints of the extremities are rare, and acute attacks are like gout. It can also be attacked at night, but it is lighter, and it can cause joint deformity in the later stage. Cartilage calcification can be seen in X-ray. The examination of joint puncture fluid shows that snow crystal of pyrophosphate is not effective for colchicine treatment.
