Gouty arthritis: Understanding the disease state and management options in primary care

Abstract

Acute gouty arthritis is an inflammatory response triggered by the release of monosodium urate crystal deposits into the joint space. The disease is associated with debilitating clinical symptoms and functional impairments as well as adverse economic and quality-of-life burdens. Because gouty arthritis is typically diagnosed and managed in the primary care setting, clinicians require a thorough knowledge of the presenting clinical features, risk factors, differential diagnoses, and treatment options for appropriate management. Although generally effective, the use of currently available therapies to control gouty arthritis is challenging because many medications used to treat comorbidities can exacerbate gouty arthritis and because current agents are associated with a number of adverse events, contraindications, or both. Based on an understanding of the underlying inflammatory pathogenesis of gouty arthritis, several new agents are being developed that may provide improved efficacy.

Interplay Between NLRP3 Inflammasome and Autophagy

“…The inflammatory response is initiated by formation and deposition of monosodium urate crystals (MSU), causing subsequent release of inflammatory mediators. Over time, periodic acute gout can lead to chronic tophaceous gout, characterized by chronic pain, chronically stiff, and swollen joints, as well as damage to bone and cartilage due to large deposits of crystals ( 119 , 120 ).…”

Ameliorative Effects of Cardamonin on Monosodium Urate-Induced Gouty Arthritis through Inhibiting NLRP3 Inflammasome Mediation

“…Chronic gouty arthritis is characterized by intense inflammation, persistent joint abnormalities, and in some cases nephrolithiasis [ 34 ]. The initiation of an inflammatory response is caused by the formation and deposition of MSU, leading to the subsequent release of inflammatory mediators [ 35 , 36 ]. Detection of intracellular crystal is essential in diagnosing crystal-induced gouty arthritis because extracellular crystal can be detected as an incidental finding or contamination.…”

Use of platelet‐rich plasma in treating a wound infection following tophi rupture: A case report

“…Po-Cheng Shih 2,3 Tai-Yuan Zhong 4 Se-Rong Wang 4 Hong-Mei Zhu 4 F I G U R E 1 Comparison of the wound on the left foot before and after PRP treatment.…”

“…The development of tophus is common in patients with uncontrolled serum urate and leads to severe and chronic gout. 2 The formation of subcutaneous tophus leads to erosion of surrounding bone and the soft tissues and development of a yellow-white neoplasm. In severe cases, tophi could result in joint deformities, bone destruction, skin ulcers, and discharge of powdery or pasty substances from wounds; thus, the wound healing is a difficult challenge.…”