Gout

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Gout is a type of disease characterized by abnormal metabolism of uric acid, resulting in an excess of uric acid inside the tissues and blood. Patients living with gout either produce too much uric acid or more commonly, their kidneys are inadequate in removing the condition. There are many possible consequences of this buildup of uric acid in the human body, including acute and chronic gouty arthritis, kidney stones, and local deposits of uric acid (Tophi) in the skin and other tissues. Gout can occur alone (primary gout) or may be associated with other medical conditions or medications (secondary gout). The prevalence of gout appears to be increasing. It is currently estimated to affect over 6 million throughout the population. Gouty arthritis is a common cause of a sudden onset of a painful, hot, red, swollen joint, particularly in the foot at the big toe. It is definitively diagnosed by detecting uric acid (monosodium urate) crystals in an aspirated sample of the joint fluid. These uric acid crystals can accumulate in the joints and tissues from around the joint over years, intermittently triggering repeated bouts of acute inflammation. Repeated attacks of gouty arthritis, or flares, can damage the joint and lead to chronic arthritis. Fortunately, while gout is a progressive disease, there are effective medications to treat gout.

Causes & Symptoms

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Uric acid is formed within the body as a breakdown product of substances called purines. Purines are found in foods such as red meat, shellfish, and offal, as well as some kinds of alcohol including beer and stout. One of the most common factors associated with the development of gout is excess alcohol intake, particularly beer. The purines found in foods generally account for up to 10% of the total purines found in the body. As redundant cells are broken down during the digestion of food, purines are converted into uric acid, which is then transported into the bloodstream as salts known as urate. Urate is usually excreted by the kidneys. However, if uric acid is produced in excess or if the urate excretion process is compromised, uric acid can accumulate to an abnormal level within the blood. Over several years ahead, hard and needle-shaped sodium urate crystals then form. Normally, the cause of a high blood urate level is inadequate excretion of urate via the urine; however, other causes may include a high amount of diet in uric acid, stress, crash dieting, dehydration, injury, persistent illness, and the use of some drugs such as diuretics or aspirin. Less commonly, gout is caused by a genetic tendency to produce too much uric acid. Not all people who have a high blood urate level develop gout, although, this is more likely to occur if a person is overweight. Following a healthy diet and maintaining a normal weight can reduce the likelihood of gout development.

Sometimes gout is accompanied by the presence of other health conditions such as hypertension, diabetes, angina, stroke, psoriasis, poor circulation, or kidney disease. The presence of gout may therefore be a warning sign of another underlying condition the patient is unaware of. Gout develops rapidly, often within 12 to 24 hours, and tends to come and go. Signs and symptoms of a gout attack may include:

 

  • Severe pain and tenderness within the affected joint.
  • Swelling of the affected joint.
  • The skin over the joint may feel warm and tight and may look shiny and red.
  • Limited range of motion in the affected joint.

 

Some people may also experience nausea, a loss of appetite, and a slight fever.

Who Gets Gout?

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This common disease affects more to men than women, usually between the ages of 30 and 60 years old. After menopause, however, women’s uric acid levels approach those of men. Among men, the condition tends to occur after puberty, whereas among women, it is unlikely to develop before menopause is reached. In about one in ten types of cases, those affected by gout have a family history of the condition. For many people who develop gout, the condition is painful and debilitating enough to restrict simple, day-to-day activities and can lead to people taking time off work. If other members of a person’s family have had gout, the individual is more likely to develop the disease. If he or she is overweight, the body produces more uric acid and the kidneys have a much more difficult time eliminating uric acid. I will describe a number of risk factors that are related to the development of gout targeting whoever can experience this disease. These include:

 

  • Obesity

 

  • High alcohol intake

 

  • A genetic predisposition

 

  • High intake of foods rich in purines (seafood and red meats)

 

  • Certain medicines (diuretics and/or fluid tablets)

 

  • Injury to a joint

 

  • Long-standing kidney disease

 

High uric acid levels are more likely to be caused by the body not eliminating uric acid properly than by what a person eats and drinks. If a parent from a patient had experienced gout before, then that specific patient has a 20% chance of developing gout.

Maori and Pacific’s people are also at a high risk of developing gout because they have genes that make it harder to eliminate uric acid from their bodies. Anyone who has a sudden onset of a hot, red, swollen joint should seek medical care, either with a primary physician, at an emergency department, or with a rheumatologist (arthritis and gout specialist). These symptoms can also be due to an infection, loss of cartilage in the joint, or other certain reasons. It is important to make an accurate diagnosis of gouty arthritis for optimal treatment.

How Does It Affect You? How Serious Is It?

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Patients who are experiencing gout can develop even more severe conditions, such as:

 

  • Recurrent gout – Some people may never experience gout signs and symptoms again. Others may experience gout several times each year. Medications can help prevent gout attacks in people with recurrent gout. If left untreated, gout can cause erosion and destruction of an affected joint.

 

  • Advanced gout – Untreated gout may cause deposits of urate crystals to form under the skin in nodules by the name of tophi. Tophi can develop in several years, such as the fingers, hands, feet, elbows, or Achilles tendons along the backs of the ankles. Tophi usually aren’t painful, although, they can become swollen and tender during gout attacks over a period of time.

 

  • Kidney stones – Urate crystals may collect in the urinary tracts of people with gout, causing kidney stones. Medications can help reduce the risk of developing kidney stones.

 

Recommended Treatment

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Medical treatment is aimed at relieving the pain and inflammation of acute attacks and preventing the occurrence of future attacks. Diet and lifestyle changes also help to prevent future attacks of gout. The more promptly that effective treatment is commenced, the more quickly the attack can be maintained. The different types of medications used include:

 

  • Medications to reduce pain – Particularly non-steroidal anti-inflammatory medications (NSAIDs) like ibuprofen. Taken early in the attack, they can reduce the duration and severity of the attack. Paracetamol, taken in conjunction with other medications, can also help reduce the pain greatly. Aspirin should be avoided as it can reduce the amount of uric acid excreted by the body.

 

  • Colchicine – This medication helps to block the production of uric acid. It is most effective when taken early in an attack. However, it can have side effects such as diarrhea if too much is taken. Dosage instructions should be followed carefully.

 

  • Corticosteroids – Such as prednisone may be given in tablet form to help reduce pain and inflammation. Corticosteroid injections directly into the affected joint may also be effective.

 

Drinking extra water while taking these medications is highly recommended. The affected joint should also be rested and elevated.

As to a diagnostic from a doctor, I will describe about three types of diagnosis on how he or she will identify any signs of gout development:

 

Joint aspiration – This is the most important diagnostic test. It is the ultimate method of being certain of a diagnosis of gouty arthritis, as opposed to other causes such as an infection in the joint. A needle is inserted directly into the joint to withdraw a sample of fluid for further testing. The fluid is then examined under a microscope to observe if there are gout crystals or signs of a bacterial infection present. Sometimes, other crystals can be discovered within the joint fluid, such as calcium pyrophosphate, which is caused by an entirely different condition called pseudogout. Gouty arthritis is sometimes diagnosed based on the typical clinical presentation without a joint aspiration.

 

Blood tests – A doctor may obtain a blood sample to look at cell counts, uric acid levels, kidney function, etc. Unfortunately, the level of uric acid in the blood cannot be reliably used to make a diagnosis of gout. It is usual in approximately 10% of people during an acute attack of gouty arthritis. Moreover, uric acid levels are elevated in 5% to 8% of the general population, so the presence of an elevated level does not necessarily mean that gout is the cause of an inflamed joint. Interestingly, uric acid is typically lowered during a flare of inflammatory gouty arthritis. Therefore, the optimal time to measure the uric acid is after a flare has resolved when acute inflammation is not present.

 

Radiographs – X-rays are primarily used to assess underlying joint damage, especially in those who have had multiple episodes of gouty arthritis.

Alternative & Homeopathic Treatment

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Despite how difficult it may be to fight against gout, there are a few home remedies that will help reduce this condition greatly. Preventing attacks of gout is as important as treating the symptoms of gout. Ways in which gout can be prevented include the use of medications and lifestyle changes. Throughout medications I have mentioned earlier, the mainstay drug for people with gout is allopurinol, which acts to reduce uric acid production. People who cannot take allopurinol due to side effects or other particular reasons may be prescribed alternative medications that either reduce uric acid production or increase the excretion of uric acid by the kidneys. In the initial stages of treatment with medications to prevent gout, attacks may occur more constantly and may be more severe. For this reason, the dosage of the medications may be low, to begin with, and is then gradually increased. These medications should only be discontinued on the advice of a doctor as stopping and starting them can also bring closer a gout attack.

Dietary modifications changes in diet are aimed at restricting or avoiding foods high in purines. Purines are again substances found in some foods and produce uric acid when broken down by the body. Foods high in purines include:

 

  • Shellfish (pipis, paua, oysters, mussels)
  • Offal foods (brains, liver, kidney, tripe)
  • Red meat (beef, pork/bacon, lamb)
  • Yeast extracts (Marmite, Vegemite)
  • Foods containing yeast (bread, beer)
  • Oily fish (sardines, herrings, and anchovies)

 

Limiting alcohol intake is also important. Alcohol causes the body to lose fluid (by increasing urine output and drawing water from the blood), thus increasing the uric acid levels in the blood. Beer is rich in purines so should be avoided. Drinking plenty of non-alcoholic fluids especially water (8 to 10 glasses a day) is highly recommended. This will help to flush the uric acid crystals out of the body. Soft drinks, fruit juice, and drinks sweetened with fruit sugar (fructose) are best avoided as they can increase uric acid levels. Maintaining a healthy weight will help reduce stress on affected joints and decrease the likelihood of developing gout.

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