Gout

GOUT

What is gout?

Gout is the most common type of inflammatory arthritis. Gout causes intense pain, swelling, redness and stiffness in one or more joints, especially in the joint of the big toe but can affect any joints of your body like elbows, knees, ankles or hands. Gout can be either acute or chronic. Mostly men are affected by gout but women can also be affected with this after the menopause.


Arthritis is a condition that causes swelling and pain in your joints. It is caused by an excessive amount of uric acid in your body. Uric acid is a natural substance in your blood and is filtered by the kidneys. If the uric acid level is too high, urate crystals can form in the joints. This can cause pain and swelling in the joints.


With gout, you do not suffer from continuous pain all the time. Gout attacks can come suddenly and are extremely painful and sometimes hard to control. Severe attacks of gout are called flares or flare-ups. When the gout attacks subside, you may feel well for months or even years, but the attacks may recur and become more frequent.


Types of gout

Medically there are various gout progress stages and they are:


Asymptomatic phase:   At this stage, uric acid levels are elevated in the blood but do not show any symptoms like pain or swelling. Not all patients with high uric acid will have an acute attack but high uric acid levels in the blood can damage tissue silently.

Acute gout:   At this stage, uric acid crystals are deposited around the joint, causing sudden swelling and intense pain. This is commonly referred to as a gout attack or flare and it may last a few days to few weeks.

Interval gout:   This stage is the period in between acute gout attacks. These periods become shorter as a gout progresses and you may not experience any symptoms, but the uric acid level remains high in the blood.

Chronic gout:   At this stage, you can have chronic arthritis and develop tophi in the joints. Chronic gout typically occurs after many years of acute gout attacks. This may result in permanent damage to the affected joints, leading to joint deformity, chronic pain and restricted mobility.

Pseudogout:   Deposition of calcium pyrophosphate crystals occurs in this stage. The symptoms of pseudogout are very similar to those of gout, although the flare-ups are usually less severe. The reason for pseudogout could be idiopathic or unknown or caused by other medical conditions.

Focal (Partial) seizures:   These seizures affect just one part of the brain.


Causes of gout

Gout is caused by the deposition of urate crystals such as monosodium urate and calcium pyrophosphate crystals in the joint spaces causing the inflammation and intense pain of a gout attack. Deposition of crystals is always caused by elevated levels of uric acid in the body. Uric acid precipitates and forms these crystals deposited in different joints throughout the body where they react with joint tissue and cause gout. The most common conditions that can cause gout are:


  Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes either your body produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needle-like urate crystals in a joint or surrounding tissue.

  Purines are natural substances in your body and consuming high-purines food may cause gout. Purines are also found in certain meat foods such as red meat and organ meats (liver) as well as seafood such as anchovies, sardines, mussels, scallops, trout and tuna.

  Excess consumption of drinks with fruit sugar (fructose), alcoholic beverages mainly beer promote higher amounts of uric acid.

  Genetic reason is one of the common causes to acquire gout.

  Gout is more common in men than in women usually between the ages of 30 and 50, whereas women often develop symptoms after menopause.

  Surgical procedures and accidental injuries can also set off gout.

  Gout is caused by a number of diseases and situations. Chronic illnesses like high blood pressure, diabetes, improper metabolism, heart and kidney disease are among them.

  Your body produces more uric acid when you're overweight and your kidneys have to work harder to clean it.

  Low-dose aspirin and various hypertension drugs, such as thiazide diuretics, angiotensin-converting enzyme (ACE) inhibitors, and beta-blockers, might raise uric acid levels.


Symptoms of gout

The signs and symptoms of gout almost occur suddenly and frequently at night. They are as follows:

Intense joint pain:   Gout usually affects the big toe, but it can occur in any joint such as ankles, knees, elbows, wrists and fingers. The pain is likely to be most severe within the first 4 to 12 hours after it begins.

Lingering discomfort:   After the most acute pain has subsided, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints.

Inflammation and redness:   The affected joint(s) become swollen, tender, warm and red.

Limited range of motion:   As gout progresses, you may not be able to move your joints normally.


How is gout diagnosed?

Doctors usually diagnose gout based on your symptoms and the appearance of the affected joint. These tests include:


Joint fluid test:   Your doctor may use a needle to draw fluid from your affected joint. Urate crystals may be visible when the fluid is examined under a microscope.

Blood test:   A blood test is helpful to measure the uric acid levels in your blood. Some people have high uric acid levels but never experience gout. On the other hand, some people have signs and symptoms of gout but don't have high levels of uric acid in their blood.

X-rays:   Joint X-rays may be helpful to rule out other causes of joint inflammation, to confirm the cause and line of treatment for chronic gout.

Dual-energy computerized tomography (DECT):   This test combines X-ray images taken from many different angles to visualize urate crystals in joints.

Ultrasound:   This test uses sound waves to detect urate crystals in joints or in tophi.


Treatment of gout

Gout can be treated with medications, diet and lifestyle changes.


Medications to treat gout attacks:   These medications help to reduce the inflammation and pain associated with gout attacks and also help to prevent future attacks. These drugs include:


Nonsteroidal anti-inflammatory drugs (NSAIDs):

   Ibuprofen   ( Advil, Motrin IB )

   Naproxen sodium   ( Aleve )

   Indomethacin   ( Indocin, Tivorbex )

   Celecoxib   ( Celebrex )


Colchicine:

  Colchicine ( Colcrys)

   Gloperba

   Mitigare


Corticosteroids:

   Prednisone


Medications to prevent gout complications:   These medications help to prevent gout complications by lowering the amount of uric acid in your blood. These drugs include:


Medications that block uric acid production:

   Allopurinol   ( Aloprim, Zyloprim )

   Febuxostat   ( Uloric )


Medications that improve uric acid removal:

   Probenecid


Diet:  

   Avoid purine rich foods: Red meat, organ meat (liver), seafood such as anchovies, sardines, mussels, scallops, trout and tuna.

   Reduce sweetened beverages: Drinks with fruit sugar (fructose), alcoholic beverages mainly beer

   Increase Vitamin C rich foods: Cherry juice and other citrus fruits.


Lifestyle management:   Person with epilepsy can take the following steps to reduce risks related to seizure:

   Visit your doctor regularly and talk about any changes in symptoms or new symptoms.

   Take your prescribed medications regularly.

   Even though application of ice packs may be temporarily relieving but should be avoided as that will aid the crystallization of uric acid.

   Maintain your overall health by doing exercise and meditation.

   Exercise regularly to lose obesity.


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