kihti

Kihti, known in medical literature as gout, is a form of inflammatory arthritis caused by hyperuricemia, leading to deposition of monosodium urate crystals in joints and soft tissues. The most common presenting symptom is a sudden, severe episode of joint pain, swelling, redness and warmth, frequently in the big toe (podagra), but the ankles, knees, wrists, and fingers may also be affected. Attacks often start at night and last days to weeks. With time, recurrent flares and tophi can develop, and kidney stones may occur in some people.

Causes and risk factors: It results from overproduction or underexcretion of uric acid by the kidneys. Risk factors include obesity, metabolic syndrome, hypertension, chronic kidney disease, diuretic use, high-purine diet (red meat, certain seafood), excessive alcohol intake (especially beer), dehydration, and genetic predisposition.

Diagnosis: Diagnosis is based on clinical presentation and laboratory tests. Serum uric acid levels may be elevated, though uric acid can be normal during an attack. Definitive diagnosis is made by examining synovial fluid or tophus fluid for needle-shaped monosodium urate crystals that appear negatively birefringent under polarized light. Imaging, such as ultrasound or dual-energy CT, can detect crystals and tophi.

Treatment: Acute flares are treated with NSAIDs, colchicine, or corticosteroids. Long-term management aims to lower serum urate levels, typically with urate-lowering therapy such as allopurinol or febuxostat, and sometimes probenecid or pegloticase for refractory cases. Lifestyle changes include hydration, weight management, reducing purine intake, and limiting alcohol.

Prognosis: Proper management reduces attack frequency and prevents joint damage. Poor control can lead to chronic gout with tophi and kidney stones.