Gouty arthritis - short, point-wise

1. Definition:
   A form of inflammatory arthritis caused by deposition of monosodium urate crystals in joints.
2. Cause:
   High blood uric acid (hyperuricemia) due to excess production or reduced kidney excretion of uric acid.
3. Common site:
   Usually starts in the first metatarsophalangeal joint of the big toe (podagra). It may also affect ankle, knee, wrist, or elbow.
4. Symptoms:
   • Sudden, severe joint pain, often at night
   • Swelling, warmth, redness, and marked tenderness
   • Attacks typically peak within 24 hours and resolve over days to 1-2 weeks.
5. Risk factors:
   Male sex, obesity, alcohol especially beer, high-purine foods such as red meat and seafood, dehydration, kidney disease, diuretics, and some metabolic disorders.
6. Diagnosis:
   Best confirmed by finding needle-shaped, negatively birefringent urate crystals in joint fluid. Serum uric acid may be normal during an acute attack.
7. Acute treatment:
   NSAIDs, colchicine, or corticosteroids, selected based on the person's kidney function and other conditions. Rest and ice can help.
8. Long-term prevention:
   Urate-lowering therapy, usually allopurinol, may be used for recurrent attacks, tophi, kidney stones, or chronic gout. The aim is to lower serum urate and prevent crystal formation.
9. Complications:
   Repeated attacks can cause chronic joint damage, tophi (urate deposits under the skin), and uric-acid kidney stones.
10. Lifestyle advice:
    Maintain healthy weight, drink adequate water, limit alcohol and sugary drinks, and reduce excess intake of organ meat, red meat, and certain seafood.