Purine metabolism and hyperuricemic states. 'The point of view of the rheumatologist'.

Gout is among the most common causes of acute monoarticular arthritis. It is characterized by depositions of monosodium urate crystals in a joint or in soft tissues, causing an acute inflammatory response. Gout typically occurs in middle age and more commonly in men. The four phases of gout include asymptomatic hyperuricemia, acute gouty arthritis, intercritical gout and chronic tophaceous gout. The initial attack usually affects a single joint, although multiple joints can be affected, especially in women. Early treatment (within 24 h) is the key to effective treatment in an episode of acute gouty arthritis. Colchicine, the traditional agent used, is more specific for gout than the NSAIDs. Treatment for hyperuricemia should be initiated in patients with frequent gout attacks, tophi or urate nephropathy. Although hyperuricemia is a major risk factor for the development of gout, acute gouty arthritis can occur in the presence of normal serum UA levels. Patients with asymptomatic hyperuricemia do not require treatment, but efforts should be made to lower their urate levels by encouraging them to make changes in diet or lifestyle. An epidemiological link between elevated serum UA level and cardiovascular risk has been recognized. Hyperuricemia in hypertensive subjects may represent an early indicator of hypertensive cardiorenal disease.