Intercritical gout

Last revised by Assoc Prof Craig Hacking on 18 Aug 2021

Intercritical gout is the asymptomatic stage between attacks of acute gouty arthritis.

During the asymptomatic phase, the joints may be non-tender and without erythema or swelling. Patients can experience multiple gout attacks with asymptomatic periods of several months in between.

During the acute gouty arthritis phase, chemotactic factors are produced to recruit macrophages which remove monosodium urate crystals and facilitate apoptotic cell removal. This process helps produce anti-inflammatory cytokines and stops the inflammatory process. As a result, the cellular and chemokine activation are suppressed, and the acute phase is terminated 1.

Most radiological findings of gout are due to repeated inflammation and joint degeneration. No radiological features are specific for the initial presentation of acute gouty arthritis. Joint degenerative changes occur in the chronic stages of gout.

Treatment involves symptomatic relief for acute attacks of gout with non-steroidal anti-inflammatory drugs (NSAIDs), steroids, or colchicine.

Long-term management will involve urate-lowering medications such as xanthine oxidase inhibitors, uricosuric drugs, or uricase agents 2.

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