Gout

Gout – causes and symptoms

Gout is caused by a raised level of uric acid in the blood stream. When different foods, like protein, are broken down and digested uric acid is produced. When the patient is experiencing an attack of gout uric acid crystals are left in the cartilage of the joints and specific tendons. This causes inflammation, swelling and severe pain.

Gout is a very common type of arthritis and quite often only affects one bone joint at a time, typically the big toe joint. However, patients with gout can also suffer pain in the elbows, wrists, hands and fingers. Also in the knees, ankles, feet and joints of the small toes.

Gout is a disease that is the result of a congenital condition with the metabolism of uric acid so it is also known as ‘metabolic arthritis’. Excess uric acid may also cause kidney stones. It is not unusual for patients with gout to experience a mild fever, redness, warmth and stiffness of the joint affected.

Gout – the pain

Uric acid crystals in the cartilage of the joints and tendons create severe pain when the joint is moving. The inflamed area can feel tender and sore.

Gout – frequency of attacks

Gout attacks, if not treated, could last for a week and yet will often subside, without treatment, after three to five days. The first attack of gout may not be repeated until weeks, months or years later, maybe never. If the attacks are repeated then without the appropriate treatment they can last longer and become more frequent.

Gout – risk factors

The main risk factor is high levels of uric acid in your body. Many of the factors listed below are connected to the increase of uric acid in your body:

High blood pressure (hypertension)

Diabetes

Narrowing of the arteries (arteriosclerosis)

Medicines: thiazide diuretics – low-dose aspirin – anti-rejection drugs

Sex and Age – men are affected by gout more than women. The first attack could be at any age but frequently happens between ages 40 and 50. Gout in women usually appears after menopause

Family history – gout can also be hereditary

Dietary factors – excessive alcohol, overweight, over-eating, severe sudden illness, surgery, fluid tablets, not drinking enough fluid and crash dieting

Gout – tests and diagnosis

To arrive at a diagnosis a doctor may perform one or more of the following procedures as there is no single conclusive test:

a medical history check [to include family history]

a physical examination

Test for Hyperuricemia – Hyperuricemia [elevated plasma urate level] is a common factor but does not mean the patient will definitely develop gout. 66% of people who have active gout have normal levels.

A blood test to calculate the amount of uric acid in the blood. The level is usually higher during an attack but can remain at the patient’s normal levels.

also, blood tests are carried out to exclude other causes of arthritis:

electrolyte

a full blood count

renal function panel

erythrocyte sedimentation rate (ESR)

Testing urine samples to measure the level of uric acid being discharged

X-Rays of the affected joints

Aspirated fluid sample taken from the afflicted joint – this procedure can prove to be difficult and consequently the patient will experience pain. The objective is to use light microscopy to find urate crystals

Gout – treatment

Drug therapies frequently prescribed include:

corticotropin

corticosteroids

NSAID’s (Non-steroidal anti-inflammatory drugs)

Clinical Therapy:

For long-term prophylaxis researchers determined that prophyactic colchicine and urate lowering therapy are successful.

Dietary changes:

If you want to reduce the risk of more gout attacks then you should avoid a high protein diet and purine rich foods.

Purine rich foods include:

Yeast – sardines – hearts – herring – sweetbreads – mussels – smelt – sweetbreads

Foods that have a moderately high purine content include:

Bacon – turkey – goose – scallops – veal – partridge – haddock – anchovies – pheasant –

Mutton – liver – grouse – salmon – kidneys – trout

Gout – what you can do

With the correct diagnosis and management of gout the prognosis for people with gout is generally very positive but with all types of arthritis, action by the patient will provide better results if:

the patient takes the trouble to learn about and understand their medical condition

the patient becomes familiar with techniques to help manage their arthritis

the patient begins treatment as soon as possible

the patient should consult their doctor / rheumatologist on a regular basis to keep up to date with new arthritis management techniques and treatment

Gout – prevention

You cannot prevent the onset of gout entirely, however, by adopting preventative care the symptoms of the condition can be managed and treated to minimize pain, discomfort, and damage to joints and bones. Sufferers of gout should be capable of living long and fruitful lives.

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Arthritis