GOUT

 GOUT:

Introduction:

  • Gout is a complex and common form of arthritis that can affect anyone. It is characterized by sudden, severe attack of pain, swelling, redness and tenderness in the joints and often at the joints at the base of big toe.
  • Any attack of gout can occur suddenly often waking you up in the middle of night with the sensation that your big toe is on fire. The affected joint is hot, swollen and so tender that even the sheet on it may seem intolerable.
  • Gout symptom may come and go, but there are ways to manage symptoms and prevent flares.

Definition:

Gout is a kind of arthritis caused by a build up of uric acid crystals in the joints. Uric acid is a breakdown product of purines that are part of many foods that we eat. An abnormality in handling of uric acid and crystallization of these compounds in joints can cause attack of painful arthritis, kidney stones and blockage of the kidney filtering tubules with uric acid crystals, leading to kidney failure.

Symptoms:

The small joint at the base of the big toe is the most common site for an attack. Other joints that can be affected include ankles, knees, wrists, fingers and elbows. The signs and symptoms of gout almost always occur suddenly and often at night. This includes:

  • Intense joint pain: Gout usually affects the large joints of our big toe but it can also occur in any joint. Other commonly affected joints include the ankles, knees, elbows, wrist and finger. The pain is likely to be most severe within the first 4-12 hrs after it begins.
  • Linguing discomfort: After the most severe pain subsides, some joints discomfort may last from a few days to few weeks. Later attacks are likely to last longer and affect more joints.
  • Inflammation and redness:  The affected joints become swollen, tender, warm and red.
  • Limited range of motion: As gout progress, we may not be able to move joints normally.

Doctor advice:

When you experience sudden or intense pain in a joint, go to doctor. Gout that goes untreated can lead to worsening pain and joint damage. Seek medical care immediately if we have a fever and a joint is hot and inflamed which can be a sign of infection.

          

Causes:

There are a variety of factors that can play a role in causing it. There are a variety of factors that can play a role in causing it. Certain conditions such as blood and metabolic disorders can cause our body to produce too much uric acid. Drinking too much alcohol can also lead to excess uric acid. Certain foods can cause gout when we eat too much of them. These include shellfish; Red meat, organ meat, sweet juice and salt.

We can also develop gout if our body is not eliminating uric acid properly. If we are dehydratetd or starved, it can make it difficult for our body to excrete uric acid. This causes it to build up as deposits in our joints. Some disease or disorders such as kidney or thyroid problem can also impair our body ability to excrete uric acid. Certain medications include diuretics and immunnosuppresive fungal medications such as cyclosporine. 

  1. Gout can cause by the accumulation of urate crystals in one joint which can cause inflammation.
  2. Formation of urate crystals occur when we have high level of uric acid in our blood.
  3. Your body produces uric acid when it breaks down purines substances that are found naturally in our body.
  4. Purines are also found in certain foods such as steak, organ meat or seafood. Other foods also promote higher levels of uric acid, such as alcohalic beverages especially beer and drinks sweetened with fruit sugar or fructose.
  5. Normally uric acid dissolves in your blood and passes through our kidneys into your urine. But sometimes either your body produces too much uric acid or your kidneys excite too little uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up and form sharp needle like urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.

Stages of Gout:

There are four stages of gout:

  1. Asymptomatic hyperuricemia: Hyperuricemia happens when you have too much uric acid in your blood; if you have no other symptom, it is called asymptomatic hyperurecemia.
  2. Acute Gout: It happens when hyperurecemia condition causes uric acid crystals to develop in one of your joints. This causes intense pain and swelling. The joints may also feel warm. There symptoms will probably shown up suddenly and last for 3-10 days. We may experience multiple acute gout attacks over a period of months or years.
  3. Interval Gout: Interval gout is the period between acute gout attacks. It is also called as inter-critical gout. We will not find any symptoms during this stage.
  4. Chronic Tophaceous gout: Chronic tophaceous gout can happen if we have gout untreated. It can take 10 year or longer to develop. In this stage, hard nodules(tophi) develop in our joints and the skin and soft tissue surrounding them. Tophi can also develop in other parts of our body, such as ears. They can cause permanent damage to our joints.

          

Risk factor for Gout:

  1. Age: Men between the age of 40 and 50 years old and post menopausal women are more likely to develop gout.
  2. Gender: Men are more likely to develop gout than women.
  3. Family history: If we have someone in our family with the history of gout, we are more likely to develop it.
  4. High blood pressure: Those individuals with high blood pressure are at the risk of gout.
  5. Diet: Eating too much purine rich foods raise our risk of gout. Red meat, organ meat and certain fish contain a lot of purine.
  6. Drinking alcohol: drinking more than two drinks a day puts us at high risk of gout.
  7. Obesity: Obese people are more prone to the gout disease like excessive weight gain especially in youth.
  8. Soda: The fructose in sweet soda has recently been shown to increase gout risk.
  9. Medications: Some medications such as cyclosporins and diuretics person are at high risk of gout.
  10. Bypass surgery: Those persons who have undergone bypass surgery are more prone to gout.
  11. Other health conditions: High blood pressure, kidney disease, thyroid disease, sleep apnea and diabetes can raise our at high risk of gout.

          

Diagnosis of Gout:

On the basis of review of medical history or physical exams and other symptoms, doctor can make a diagnosis. Doctor can diagnose disease on the basis of description of joint pain, how often we experience intense pain in the joints and how red or swollen the area. Doctor can also conduct a test to check for build up of uric acid in the joints. They will collect a sample of fluid from our joint to learn if it contains uric acid. Gout can also be analysed by another technique:

  1. Joint fluid analysis: Once joint fluid is obtained, it is analyzed for uric acid crystals and infections. Doctor may also do a blood test to measure the amount of uric acid in our blood.
  2. X-Ray examination: X- Ray examination of joint will also be conduct. 
  3. Detection of uric acid crystals: The most reliable test for gout is the detection of uric acid crystals.

Treatment of Gout:

In most cases regular examination by doctor can treat this disease, if we have severe complications or chronic tophaceous gout is develop then doctor can refer the patient to rheumatologist. These types of doctors are specialized in arthritis. Doctor prescribed treatment plan will depends on the stages and severity of gout. Doctors may prescribe:

  • Colchicine to reduce pain in joint.
  • Non- steroidal and inflammatory drugs (NSAIDS) such as ibuprofen or naproxen to reduce inflammation and pain in joint.
  • Corticosteroids such as prednisone to reduce inflammation and pain in joints.
  • Medications to reduce body production of uric acid such as allopurinol.
  • Medications help our body to eliminate uric acid like probenocid.
  • Along with above, doctors can also recommend lifestyle changed to help manage symptoms and reduce risk of future gout attacks. For example; doctors may encourage the patients to:
  • Adjust the diet of patients
  • Reduce the intake of alcohol
  • Loose some calories
  • Quit smoking

Complications of Gout:

Gout is the disease if it is left untreated then it can cause tophi to develop near the inflamed joints. This can also lead to arthritis, a painful condition in which the joints get permanently damaged or swollen.

          

 Prevention:

Gout can be prevented by following factors:

  • Limit the use of alcohol
  • Limit the use of purine rich food, such as shellfish, lamb, beef, pork and organ meat.
  • Eat a low fat, non- diary diet that is rich in vegetables.
  • Lose weight
  • Stop smoking
  • Exercise
  • Stay hydrated

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