What is gout?
Gout is the commonest inflammatory arthritis of men above 40 years
of age. It belongs to a major category of arthropathies that are
called ‘crystal-deposition arthritis’. This group is one of the 3
important causes of inflammatory arthropathies (the other 2 being
immunoinflammatory category – rheumatoid arthritis belongs to that
group; and infection that cause septic arthritis).
The majority of the patients with gout are men above the age of 40
years. A gouty attack usually starts in the middle of the night
after a big party where the patient might have indulged in heavy
eating and drinking. There is a sudden acute severe painful
swelling of any of the joints in the ankle-feet region, but most
often in the joint at the base of the big toe. In its acute stage,
usually a single joint is affected. The joint swells up with acute
tenderness to touch. The overlying skin becomes severely inflamed
with dusky reddish-brown discolouration. Over a period of a few
days, scaling and peeling of the overlying skin is commonly seen.
Initially, the episodes are infrequent and may last for a week,
with no symptoms between episodes.
The patients with gout have been found to be more prone to develop
blood lipid abnormalities that would make them more prone to heart
disease. Also, most of them are obese and often more prone to high
blood pressure that further increases the chance of a heart
attack.
How is it caused?
In gout, joint inflammation is triggered by the deposition of
crystals of uric acid. Uric acid is a waste product produced in
the body that passes through the kidneys into the urine. Some
people, due to their genetic makeup, do not excrete adequate
amounts of uric acid from their kidneys. This leads to a slow but
steady increase in the uric acid content of their body that may
also cause a high blood uric acid level in their blood. In a
majority of such individuals, high uric acid in the blood (and the
other body fluids) does not directly cause any health problem.
However, in a small number of such individuals, persistently high
levels of uric acid in the body fluids lead to the deposition of
uric acid crystals. Two main sites where uric acid crystal
deposition causes problems include:
The musculoskeletal system (joints, bursae, tendons, ligaments),
and
Kidneys
Most individuals who have had a few attacks of gout have high
blood uric acid levels. But, interestingly, blood uric acid levels
generally falls during acute attack of gout. However, people with
a high percentage of uric acid crystals in their body are more
prone to obesity, hypertension and many other heart problems. Such
individuals must therefore be advised to restrict their dietary
caloric intake and carry out regular aerobic workout exercises to
keep their weight under control, get their blood pressure
regularly checked and get it properly treated if it is high.
How is an attack triggered?
An acute attack may be set off by any of the following:
* Excessive alcohol intake
* Eating prohibited foods like meats
* Any stress of illness or surgery
* Injury
* Medicines that are often given for making a person pass more
urine (e.g., lasix) and anti-cancer drugs, ingestion of drugs that
are often used to lower blood levels of uric acid (e.g.,
allopurinol).
How is it diagnosed?
Gout can be diagnosed by the symptoms and medical history.
Classical symptoms of gout make diagnosis easier since it is the
most probable diagnosis in a middle aged male, who has a recent
history of heavy eating and drinking and who complains of painful
joints. The history usually reveals a similar problem in the
patient's other male relatives.
Blood tests may be performed to check for uric acid levels. The
diagnosis may be confirmed by withdrawing a sample of the joint
fluid using a small needle from the affected joint. This fluid is
full of tiny uric acid crystals that look like small needles. It
is useful to remember that a high level of uric acid in the blood
does not necessarily mean gout, nor does a normal level exclude
the possibility of gout.
What is the treatment?
Treatment of acute gouty attack requires immediate control of the
acute joint symptoms followed by strategies to prevent future
possible attacks, and joint and tissue damage due to the
deposition of uric acid crystals in the long run. Acute attack is
treated with the use of fast acting anti-inflammatory drugs.However, most of them have a major side-effect i.e. severe
irritation of the gastrointestinal tract (stomach, duodenum and
often small intestines as well).
After the acute attack subsides, the person must be investigated
to find out if has any underlying disease (especially some renal
disease) for uric acid crystal formation, he has a family history
of gout, is ingesting some drugs etc. Then if no obvious
underlying cause is found then the person is diagnosed as ‘primary
gout’ and advised:
* General positive health practices: dietary control of total
caloric intake, with special precaution against items that cause
increased production of uric acid in the body (red meat, wines,
fermented food, sprouts of all varieties), regular fitness
workouts especially aerobic exercises, control of cholesterol,
high blood pressure. It is important to reduce weight very
gradually as sudden weight loss can also precipitate an acute
attack of gout.
* Plenty of fluid intake on a regular basis.
* Avoid all the drugs that can cause acute gouty attack or raise
the blood uric acid levels (aspirin is one of them).
* If these measures do not prevent further attacks of gout and
blood uric acid remains persistently high, then, under careful
guidance of the doctor, uric acid lowering drugs can be
instituted. These include allopurinol, sulfinpyrazone, and
probenecid. They may often precipitate an acute attack of gout
when they are started. Therefore, it is necessary to take these
drugs under the guidance of the doctor who may prescribe some
additional drugs to prevent acute attack of gout during the
initiation period with these drugs.
Inflammation Of Gout Affected
Hand
Gout is a type of
arthritis
Gout is a disease that
involves the build-up of uric acid in the body
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