Gout is arthritis caused by deposition of uric acid crystals in and around the joints. The article is fully described on gout causes and treatment. It can cause an attack of sudden burning pain, stiffness and swelling in a joint. Most commonly involved joint is base of the big toe. Other joints, such as the knees, wrists & fingers, may also be affected. Hence, spine and large joints are rarely involved.
Hyperuricemia means high uric acid levels in the blood. However, having high uric acid level in the blood is not a disease in itself. Only one third of the patients with hyperuricemia manifest the symptoms i.e. gout and kidney stone. Others remain asymptomatic throughout their life and do not require treatment. Hyperuricemia is sometimes associated with other health condition i.e. diabetes, heart and kidney diseases.
2/3rd of people with high uric acid level never experience the symptoms.
Some people experience only one attack in whole life. Other shave repeated attacks unless gout is treated. Over time, they can damage the joints, tendons, and other tissues.
Furthermore, gout is most common in men. Females are usually affected in postmenopausal age.
Features of Acute Attack
Marked swelling, pain & redness of the involved joint
Rapid onset, reaching maximum severity in 2 – 6 hours
Often waking the patient in early morning often described as the ‘worst pain ever’
Self limiting, resolves over 5 – 14 days.
Triggers of Gout
- Chances of getting gout are higher in:
- Overweight people
- Excessive alcohol consumption
- Intake of high purine containing foods i.e. meat and fish
- Also with the use of medications like diuretics
How to diagnose gout?
Diagnosing gout is usually based on the typical symptoms and physical examination findings of acute gouty arthritis. Likewise joint fluid can be aspirated and examined under the microscope. For the identification of uric acid crystals. Measuring uric acid level during the acute attack can give falsely low or normal. Ideally levels should be checked when acute attack has settled.
- Treatment of acute gouty arthritis
- Prevention’s of recurrent attacks
Treatment of Acute Gouty Arthritis
- Have rest and raise the affected limb
- Stay well hydrated
- Furthermore medications used to treat acute attacks are:
- Non – steroidal anti –inflammatory drugs; diclofenac, naproxen, celecoxib etc
- Corticosteroid. Corticosteroid can be given either as tablet or injection. Intramuscular or into the joint directly.
Preventions of Recurrent Attacks
Certainly lifestyle changes can help in reducing risk offurther attacks of gout, including:
- Avoiding foods containing high levels of purines. Such as red meat, offal, oily fish, seafood and foods containing yeast extract.
- Avoiding sugary drinks (fructose containing) and snacks
- Maintaining a healthy weight
- Regular exercise
- Adequate water intake
- Also limiting alcoholic beverages
Uric Acid Lowering Therapy (ULT)
While the medications for lowering the uric acid can be used in selected patients. These are given in patients who have repeated attacks. Usually 2 or more attacks of acute arthritis in last one year. Not for single episode. The aim is to keep the uric acid level less than 6 mg/dl to prevent repeated attacks leading to joint damage.
These medications include:
- Allopurinol (zyloric)
- Febuxostat (Gouric)
- Also less commonly: Sulfinpyrazone, Probenecid and Benzbromarone can be used.
Recurrent Gout: some people develop recurrent gouty attack that can damage the joint if left untreated.
Chronic Gout: Furthermore, untreated gout may cause deposits of urate crystals under the skin called tophi. Untreated gout can cause joint deformity and disability.
Kidney Stones: Urate crystals deposition in the kidneys can cause stones. while the medications can help reduce the risk of kidney stones.
- Patients with high uric acid levels in the blood without any symptoms don’t require treatment.
- Gout predominantly affects men and postmenopausal women. However the postmenopausal women are rarely affected.
- Repeated attacks of gouty arthritis need uric acid lowering medications.
- Finally, lifestyle changes can help in reducing risk of recurrent attacks.
IMPORTANT NOTE: Only use the medications prescribed by your doctor.