Gout: A complex form of arthritis


Gout: Gout is a complex form of arthritis, in which defective metabolism of uric acid causes arthritis, in the smaller bones of the feet, deposition of chalk-stones, and episodes of acute pain. Gout is characterized by sudden intense pain, redness & tenderness in joints especially at joint at the base of the big toe. Women are more susceptible to be affected with gout after menopause.

The uric acid produced in body in a normal process is dissolved in blood and passed out as urine. When excessive uric acid is produced in kidney, uric acid can build up forming sharp needle like urate crystals at joints. The uric acid levels at 6.8 mg/dL or higher can lead to the formation of uric acid crystals. Gout occurs when uric acid crystals accumulate in your joints causing sudden swelling, pain, hot and inflamed joints. People with gout can develop more-severe conditions, like recurrent gout, advanced gout (deposition of under the skin in nodules called tophi), kidney stones (deposits of uric acid in urinary track).

Gout attacks occur most frequently in the joints of the feet and hands, since the body temperature at these joints is often lower than the rest of the body that increases the likelihood of crystals forming. The knees and elbows joints are the next most commonly affected joints in gout.  Joints that are closer to the body including the shoulders, hips, the neck or back are very rarely affected.

Factors that increase the risk of gout include excessive alcohol intake, genetics, gender, age, weight, certain medical conditions such as high blood pressure (hypertension), diabetes, higher levels of triglycerides, fat and cholesterol in blood (hyperlipidemia), constriction of arteries (arteriosclerosis). The use of specific category of medication thiazide diuretics, beta-blockers, ACE inhibitors and calcium channel blockers  used for treating hypertension, niacin used for reducing cholesterol, low dose aspirin is documented to have side effects of increasing uric acid levels.

The signs and symptoms of gout are sudden acute occurrence, often at night time that includes intense joint pain in ankles, feet, hands, knees and wrists; a prolonged lingering sensation of discomfort in joints, swollen, tender and redness of joints. Symptoms typically develop rapidly over just a few hours and usually last for 3 to 10 days.

If you experience intense pain in joint with fever, you should immediately consult your physician or rheumatologist. Share your medical history, health conditions for which you are receiving medication. Also share any incidence of gout in your family history.

Your doctor may prescribe joint fluid test and blood test to confirm gout.

Seek advice on your symptoms—first occurrence, description of pain, body parts affected by pain, severity of pain, tests to be conducted for confirmation of gout. Doctor would be advising medication that reduces intensity of pain and effectively removes gout pain based on your body conditions and prognosis. Further you would be advised on life-style changes including diet modification and food nutritional supplements.

Preventive care in gout includes rehydration by drinking 8 to 16 cups of fluid every day. Strictly avoid alcohol. Eat a moderated amount of proteins from sources such as low fat or toned dairy products, tofu, eggs and nut butter.

 Restrict the intake of meat products to 130-170 grams (4 to 6 ounces daily). Foods rich in purines such as Organ meats, herring, anchovies, mackerel, red meat (beef, pork and lamb), fatty fish and seafood (tuna, shrimp, lobster and scallops) are associated with increased risk of gout.

Increase the intake of foods that potentially lower uric acid levels—coffee, Vitamin C, cherries, oranges, blackberries, blueberries, purple grapes and raspberries.

Maintain an optimum body weight; lose weight if you are overweight or obese.

At higher uric acid levels 11 mg/dL, doctors usually recommend lowering uric acid with medication even if there are no gout symptoms.

Also avoid high-protein weight-loss diets, which can cause you to produce too much uric acid (hyperuricemia).

Take medication such as allopurinol, that inhibits the enzyme (xanthine oxidase) responsible for converting purines into uric acid, is a tablet taken once a day. The dose needs to be adjusted to ensure that the target level of serum uric acid well below 360 umol/L or 6mg/dl  is achieved. The side effects of allopurinol as observed in certain population include indigestion, headache and diarrhea.

Febuxostat can be administered to patients with kidney problems as it is assimilated in liver instead of kidney. Common side effects of febuxostat include an increased number of acute gout attacks, feeling sick, skin rashes, headache and diarrhea.

During a gout attack, preventive care and rest is important. Raise your limb and avoid knocking or damaging the affected joint. Cooling by removing surrounding clothing and applying ice pack to the affected joints regions such as bag of frozen peas or some ice wrapped inside a towel for around 20 minutes. Avoid directly application of ice to the joints affected by gout.



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