Disease Description (Causes and Symptoms)
- Definition summary: A disease in which uric acid, a purine metabolite, accumulates excessively in the blood, causing uric acid (monosodium urate) crystals to deposit in the joints and surrounding tissues, leading to inflammation; this is called gouty arthritis.
- Pathophysiology: Hyperuricemia develops due to increased purine metabolism or decreased uric acid excretion → uric acid crystals deposit in the joint cavity and surrounding tissues → a local inflammatory response and acute arthritis attacks. Repeated attacks can lead to tophus formation, chronic joint damage, and kidney damage.
- Main causes: A high-purine diet (alcohol—especially beer—red meat, and organ meats), overweight, certain medications (such as diuretics), reduced kidney function, and genetic or metabolic factors.
- Characteristic symptoms: Usually sudden severe pain, redness, and swelling in a single joint (especially occurring at night). It commonly begins in the big toe (1st MTP), ankle, or knee. Recurrent arthritis, joint deformity, and limited movement may occur with repeated attacks and over time. Systemic symptoms, such as fever, may accompany it.
Treatment Methods and Precautions
- Treatment of acute attacks
- First-line medications: Nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., naproxen, indomethacin) or colchicine (follow initial dose limits).
- Steroids: May be used systemically (oral/injection) or by intra-articular injection (when NSAIDs/colchicine are contraindicated).
- Treatment principle: Control pain and inflammation as quickly as possible. Consult the attending physician about starting urate-lowering therapy during the acute phase (in some situations, temporarily stopping or continuing it during the acute phase may be recommended).
- Urate-lowering (underlying disease) treatment — chronic management
- Inhibitors of uric acid production: allopurinol, febuxostat.
- Uricosuric agents: probenecid, etc. (selected according to kidney function and whether urinary tract stones are present).
- Refractory/severe tophaceous gout: Biologic agents such as pegloticase may be considered.
- Treatment goals: Generally, blood uric acid <6.0 mg/dL (a level of <5.0 mg/dL is recommended when tophi are present or attacks are recurrent). Regular blood uric acid monitoring is necessary.
- Lifestyle management (precautions)
- Abstain from alcohol (especially beer), increase fluid intake (target approximately 2 L of urine per day), avoid sudden fasting or weight loss, and limit excessive consumption of high-purine foods (organ meats, red meat, shellfish, etc.).
- Maintaining an appropriate weight and exercising are recommended (take care to avoid dehydration).
- Some medications (such as thiazide diuretics) can cause uric acid levels to rise, so consult the attending physician about adjusting medications.
- Monitoring and medication safety
- Monitor kidney function (creatinine) and liver function, as well as medication adverse effects (e.g., allopurinol-related hypersensitivity reactions and reported cardiovascular risks associated with febuxostat).
- When urate-lowering therapy is started, attacks may increase during the first several months due to fluctuations in uric acid levels → prophylactic administration of low-dose colchicine or an NSAID may be considered.
Checklist Before an Outpatient Visit (Including Items to Bring and Example Questions)
- Items to bring (recommended)
- A list of all medications and supplements currently being taken (including doses and administration times)
- Recent blood test results (uric acid, creatinine, eGFR, etc.) and records of diagnostic tests (X-ray, joint ultrasound, etc.)
- Symptom record: date and time the attack began, duration, joints involved, pain severity, fever, and triggering factors (alcohol consumption, overeating, etc.)
- The number of previous gout attacks, response to treatment, and photos showing whether tophi (subcutaneous lumps) are present
- Key information to provide to the healthcare professional during the outpatient visit (examples)
- "Do you have my recent uric acid test results and kidney function test results?"
- "Are any of the medications I am currently taking likely to affect gout?"
- "What medications did I take for the gout attack, and how much did I take? How effective were they?"
Examples of General Questions to Ask the Doctor
- "What is the best treatment to reduce this acute attack as quickly as possible?"
- "Should I start urate-lowering therapy? When should I start, and what should my target uric acid level be?"
- "Do the medications I am currently taking (or medications for other conditions) affect gout?"
- "What are the main side effects of the medication, and what symptoms should I watch for?"
Examples of Disease-Specific Questions
- "What blood uric acid level should I aim for, and how often should I be tested?"
- "I have tophi (subcutaneous nodules) or signs of kidney stones. What additional tests (ultrasound/CT/kidney tests) are needed?"
Additional information: Regular management (blood uric acid and kidney function tests) and lifestyle changes are important for preventing recurrence. Because the treatment plan and medication selection vary depending on your kidney function, comorbidities, and medication tolerability, consult your attending specialist to receive personalized treatment.