Arthritis: Gout, Spondyloarthropathies, etc.

 

Gouty arthritis refers to painful monosodium urate crystal deposits in soft tissues, causing extreme pain, especially in the great toe or hand.  Ligaments, bursa , etc. and other tissues with poor blood supply are subject to these crystals being deposited.  There are several chronic diseases that predispose to gout including coronary artery disease, obesity, alcoholism, high blood pressure, and chronic thiazide diuretic usage.  The condition initially completely resolves, then recurrences begin occurring with increasing frequency.  Initially, the joint spaces are normal on x-ray.  Treatment is avoidance of certain foods, colchicine and steroids for acute attacks, and allopurinol for prevention.

 

Spondyloarthropathies refer to other non-inflammatory sources of arthritis.  These most often involve the sacroiliac joints and are negative for rheumatoid arthritis blood tests.  However, except for psoriatic arthritis, HLA B27 is positive in 90% (normal populations have a positive test in only 10%). Ankylosing spondylitis  results in stiffening of the spine and spine pain from spontaneous spinal fusion of multiple spine segments and swelling of ligament insertions into bone, and one sided sacroiliitis. The spine eventually develops a typical bamboo appearance on x-ray.  Reiters syndrome is a post-infection syndrome from a sexually transmitted disease (chlamydia) occurring mainly in males with irritation of the eyes, urethritis or pain on urination, and arthritis of the knees, ankles, or feet.  Usually these symptoms begin several weeks after exposure.

Enteropathic arthritis is associated with crohns disease, ulcerative colitis, and irritable bowel syndrome in 20% of those having these diseases.  Sacroiliitis develops in 20% of these patients and the arthritis is usually asymmetrical lower extremity.  Fever, malaise, weight loss, and abdominal cramps are common.  Finally, Psoriatic arthritis is associated with the skin condition psoriasis.  Often, arthritis of the hands are associated with this condition.

Treatment of all these conditions varies.