Rehabilitation Guide for Total Knee Arthroplasty

Author: Bi Xia
Publisher:
Publish Date: 2006-08-01
Features: 4. Crystalline Arthritis (Gout)
Crystalline arthritis (gout) is a systemic disease caused by abnormal uric acid metabolism, more common in males with a male-to-female ratio of 20:1. Gout affects approximately 75% of cases in the big toe joint, followed by the knee joint. Deposition of uric acid crystals in joints, kidneys, or other tissues leads to damage to these organs and the formation of tophi. Gout is classified into primary and secondary types. Primary gout has a family genetic predisposition in 10% to 60% of cases. Secondary gout is often associated with hematological diseases, kidney diseases, malignant tumors, and other conditions.
Clinical Manifestations:
Most cases involve sudden, severe joint pain and redness/swelling, accompanied by joint effusion, elevated body temperature, dilated subcutaneous veins, dark red skin, and swelling that often exceeds the anatomical boundaries of the joint. After the redness and swelling subside, localized pitting edema, loose skin, itching, or scaling may persist. With repeated attacks and prolonged duration, more joints become affected, and uric acid crystals accumulate gradually in the joints, making swelling and pain difficult to relieve. This often results in joint deformity and stiffness.
Treatment:
The first step in gout treatment is dietary restriction, weight reduction, and avoiding foods high in purines or calories, as well as avoiding alcohol and mental stress. Patients with elevated blood uric acid levels may take uricosuric drugs and increase fluid intake, consuming more alkaline foods. Daily fluid intake should be increased to enhance uric acid excretion and protect the kidneys. Allopurinol is the first-line medication, continued until symptoms are controlled or side effects such as diarrhea, nausea, and vomiting occur. Symptoms typically resolve within 24 to 72 hours, with intravenous administration providing faster relief. Indomethacin (Indocin) and phenylbutazone may also be used, starting with high doses and gradually tapering.
In advanced gouty arthritis, artificial joint replacement may be considered to reduce joint pain and restore function.
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