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Gout (Gouty Arthritis)
Metabolic arthritis from uric acid crystal buildup in joint.
Pathophysiology
Hyperuricemia → urate crystal in joints (often 1st MTP: metatarsophalangeal joints) → intense inflammation
Signs and Symptoms
Sudden, severe pain
Red, hot, swollen big toe
Tophi (chronic)
Risk Factors
Male
Alcohol (beer)
High-purine diet
Diuretics
CKD
Diagnostics
Uric Acid : Elevated (> 7mg/dL)
Joint Aspiration: Needle-shaped urate crystals
X-ray : Punched-out lesions in chronic gout
Creatinine/ BUN: To assess renal function
Nursing Management
Elevate and rest joint
Avoid Alcohol and purine-rich foods
Encourage fluids (2-3L/day)
Pharmacologic Treatment
Colchicine : Decrease inflammation in acute attacks
NSAIDs : Pain and inflammation relief
Corticosteroids: For patients intolerant to NSAIDs
Allopurinol/ Febuxostat: Decrease uric acid production
Probenecid: increase uric acid excretion.
Surgical Interventions
🔪 Tophaceous Gout Surgery (Tophi Excision)
Indication: Large, deforming tophi interfering with joint function or skin integrity
Purpose: Removes urate deposits (tophi)
Post-op: Continue urate-lowering therapy to prevent recurrence; wound care important