Gout

Gout is a form of inflammatory arthritis that causes pain, swelling and stiffness in joints. It develops in people who have high level of uric acid in the blood. Uric acid is produced as part of the body’s metabolism of purines. Most of the uric acid is produced by the body naturally and the rest comes from the diet, in the form of purines. Certain food can also lead to over production of uric acid. Food rich in purines include shellfish, mushroom and organ meat. Consumption of sea food and meat increases the risk of gout attacks. Increased levels of uric acid from excess purines may accumulate in your tissue, and form crystals, which bring on a gout flare. Gout may occur alone or they may accompany other medical conditions. It has also been linked with other conditions such as cardiovascular disease, Kidney disease, Diabetes, Hypertension.

Gout is a chronic disease that worsens over time. It is more common in men than in women. It occurs more often in men between the age of 30 and 45 and women after menopause. At normal levels in blood, uric acid does not cause any damage. Body keeps the uric acid at normal level by excreting it through the kidneys in the urine.

Normal uric acid levels are:

Female: 2.4-6.0 mg/dL

Male: 3.4-7.0mg/dL

Risk factors for Gout

There are several factors that can make a person more susceptible to gout such as:

• Obesity
• Gender: It is more common in men than women. It is rare in women until they reach menopause
• Age: The most common age of onset is from 40-50 years
• High blood pressure
• Genetics
• Diabetes
• Excess body weight.

Causes

Gout develops when your body produces too much uric acid or when it does not eliminate enough of it. The most common cause is the inability to excrete enough of the uric acid in the urine. Uric acid is normally cleaned out of the body by the kidneys, and passes out of the body along with urine. However, high level of uric acid builds up in blood stream and form needle-shaped urate crystals in joint, causing the severe inflammation and intense pain of a gout attack. It can also occur due to certain medications like aspirin, diuretics or alcohol. These medications cause higher level of uric acid in the blood.

Symptoms

Gout is characterized by sudden and severe episodes of pain in affected joint followed by swelling, redness and tenderness. It often starts in the big toe but it can also affect other small joints in your feet, arms, and legs. The joint that is affected is often red and swollen and may also feel hot. The pain is so intense that you can’t stand to have it touched, even by the sheets. Gout crystals form bumps called “tophi,” which are often visible under the skin.

Diagnosis

Gout is diagnosed based on some physical examination and lab tests. It may be confused with other forms of chronic inflammatory arthritis, so it is important to diagnose adequately. Gout is diagnosed upon the finding of monosodium urate crystals in the joint fluid. Blood test can be done to check for infection as well as uric acid level. It is important to diagnose and treat it early to avoid pain and complications. Left untreated, gout can cause permanent damage to joints and kidneys.

Treatment

Treatment choices depend on kidney function, and other health problem. Certain medications available without the prescription may relieve pain. Treatment of pain and inflammation can be achieved with NSAIDs, colchicines, or corticosteroids.

Non-steroidal Anti Inflammatory Drugs (NSAID’s) – The pain and inflammation from gout can be alleviated by NSAID’s. Commonly used NSAID during gout attack are naproxen, ibuprofen. It is contraindicated in patients with ulcers, hypertension, and coronary disease.

Colchicines - Colchicines are given to reduce inflammation during an acute gout attack. It is very effective in treating gout attacks. However, high doses of colchicines can cause nausea, vomiting, and other side effects. Side effects may be less frequent with low doses. They are useful option for those patients who cannot take NSAIDs.

Corticosteroids - Doctor may also prescribe corticosteroids for acute gout attacks such as Prednisone. These are strong anti- inflammatory medications that can be taken either in pill form, intravenously or injected into the painful joint.

Lifestyle changes such as controlling weight, limiting meals rich in purines can help control gout. Patient should avoid alcoholic drinks. Consumption of dairy products and vegetables should be encouraged.

Gout Vs Pseudogout

Gout and pseudogout are common type of arthritis. Both are caused by collection of sharp crystals in joints. The main difference between gout and pseudogout are the types of crystals that deposit into the joint and cause inflammation. Gout is caused by monosodium urate monohydrate crystals whereas pseudogout is caused by calcium pyrophosphate crystals.

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