Non-Autoimmune Arthritis

Gout is a heterogeneous metabolic disease associated with elevated serum uric acid levels (> 6.8 mg/dL) and abnormal deposits of monosodium urate in tissues. The condition is often familial and is initially characterized by painful, recurring, and usually monoarticular acute arthritis, or “gout flare,” followed later by chronic deforming arthritis. The kidneys can also be affected, and urate crystals can precipitate as chalkstone-like deposits (“tophi”) in the soft tissues, synovial tissues, or in bones near the joints. Hyperuricemia is due to overproduction and/or underexcretion of uric acid and is a necessary but insufficient precondition to developing urate crystal deposition disease (most hyperuricemic individuals never experience clinical gout). The most commonly involved joint is the first metatarsophalangeal joint. The identification of urate crystals in joint aspirate or tophi is diagnostic. Effective therapies to relieve the pain of a gout flare include nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, and glucocorticoids; the choice of therapy depends on the individual and if there are any contraindications.