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The Musculoskeletal System, Part 1

1-10. GOUT

This condition is a metabolic disease characterized by an excess of uric acid in the urine. Gout usually occurs in the feet and legs and causes joints to be painfully arthritic.

a. Normal Causes of Gout. Normally, nucleic acids are catabolized, and uric acid is produced as waste. Some individuals produce too much uric acid while others excrete too little uric acid. In both cases, uric acid accumulates in the body and tends to solidify into crystals that are deposited in the joints and kidney tissue. Gouty arthritis is the term for the condition caused wthen these crystals are deposited in joints.

b. Other Causes of Gout. The tendency to gout can be inherited. Other causes of gout include renal problems (kidney problems) and overuse of diuretics. Dehydration and starvation make the condition worse. Individuals who have gout can be gout free for years. The condition is not necessarily constant.

c. Signs/Symptoms of Gout. Note the following:

(1) Sudden onset of severe pain in peripheral joints.

(2) Metatarsophalangeal joint of great toe (see figure 1-1) is most susceptible to gout.

(3) Affected joints are hot, tender, inflamed, dusky-red, or cyanotic.

(4) The patient may have a fever of 101ºF to 103ºF.

(5) Recurring episodes of gout attack the same joints.

Figure 1-1. Metatarsophalangeal joint of great toe.

d. Treatment of Gout. Follow this treatment:

(1) Advise avoidance of alcohol and purine-rich foods.

(2) Encourage large fluid intake.

(3) By physician's order, may administer nonsteroidal anti-inflammatory indomethacin medication such as Indocin®.

(4) By physician's order, may give uriocsurics such as allopurinol (Zyloprim®) and colchicine.


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