Gout

Gout is a common joint disease, especially in men

Gout is a painful condition that occurs when the bodily waste product uric acid is deposited as needle-like crystals in the joints and/or soft tissues. In the joints, these uric acid crystals cause inflammatory arthritis, which in turn leads to intermittent swelling, redness, heat, pain, and stiffness in the joints.

In many people, gout initially affects the joints of the big toe (a condition called podagra). But many other joints and areas around the joints can be affected in addition to or instead of the big toe. These include the insteps, ankles, heels, knees, wrists, fingers, and elbows. Chalky deposits of uric acid, also known as tophi, can appear as lumps under the skin that surrounds the joints and covers the rim of the ear. Uric acid crystals can also collect in the kidneys and cause kidney stones.

             


  


   

               

 

Uric acid crystals form in the joints

Gout is caused by a problem with metabolism that leads to high levels of uric acid in the blood (although occasionally levels are normal). In an acute attack, crystals of uric acid precipitate out, usually into a single joint. The most common joint to be affected is the one at the base of the big toe, but it can affect the knee, ankle, wrist, foot and small joints of the hand.

As I'm sure you could tell us, gout is extremely painful and the joint becomes swollen and red over about 24 to 36 hours. Attacks last a few days and usually improve rapidly if a course of non-steroidal anti-inflammatory drugs (NSAIDs) is started immediately. Sometimes a drug called colchicine or a steroid injection into the joint is needed.

Long-term problems

A few lucky individuals will have only one attack of gout. Most, though, have a second attack six months to two years later.

In some cases, more and more joints become involved. In the worst cases, there may be constant pain from chronic inflammation and destruction of the joint.

There's also a risk that crystals will form in the kidneys leading to kidney stones.

Preventing attacks




It's possible to take steps to prevent further attacks of gout. The aim is to control levels of uric acid in the blood. You can do this by:

  • Avoiding food rich in a group of chemicals called purines - especially Non-vegetarian food, fish, sea-food, sprouts, eggs, alcohol, sweetened drinks & soft drinks,  and thickened milk products like paneer, cheese, khowa.
  

High-Purine Foods
Foods that are high in purine include: 
   ball1.gif (1653 bytes) kidneys
   ball1.gif (1653 bytes) brain
   ball1.gif (1653 bytes) meats like rabbits, birds, ducks etc. 
   ball1.gif (1653 bytes) herring
   ball1.gif (1653 bytes) liver
   ball1.gif (1653 bytes) mackerel fish
   ball1.gif (1653 bytes) sardines
  • Avoiding excessive alcohol intake
  • Keeping your weight within reasonable levels (overweight people are at higher risk of gout)
  • Avoiding aspirin, as this increases blood levels
  • Following a drug treatment that inhibits the formation of uric acid (such as allopurinol) or increases its excretion by the kidneys (such as probenecid)
  • Check with your doctor if you're on regular medication because a number of medicines (for example, diuretics) can cause raised levels of uric acid in the blood, as can one or two diseases, which should be ruled out

Treatment

With proper treatment, most people who have gout are able to control their symptoms and live productive lives. 

Gout can be treated with one or a combination of therapies. 

The goals of treatment are to ease the pain associated with acute attacks, to prevent future attacks, and to avoid the formation of tophi and kidney stones. 

Successful treatment can reduce discomfort caused by the symptoms of gout, as well as long-term damage to the affected joints. Treatment will help to prevent disability due to gout.


The most common treatments for an acute attack of gout are nonsteroidal anti-inflammatory drugs (NSAIDs) taken orally (by mouth), or corticosteroids, which are taken orally or injected into the affected joint. 

NSAIDs reduce the inflammation caused by deposits of uric acid crystals, but have no effect on the amount of uric acid in the body.

The attack usually goes away completely within a week or so.

When NSAIDs or corticosteroids do not control symptoms, the doctor may consider using colchicine. This drug is most effective when taken within the first 12 hours of an acute attack. Doctors may ask patients to take oral colchicine as often as every hour until joint symptoms begin to improve or side effects such as nausea, vomiting, abdominal cramps, or diarrhea make it uncomfortable to continue the drug.

For some patients, the doctor may prescribe either NSAIDs or oral colchicine in small daily doses to prevent future attacks. The doctor also may consider prescribing medicine such as allopurinol (Zyloric), febuxostat or probenecid (Benemid) to treat hyperuricemia and reduce the frequency of sudden attacks and the development of tophi.

People who have other medical problems, such as high blood pressure or high blood triglycerides (fats), may find that the drugs they take for those conditions can also be useful for gout. Both losartan (Cozaar), a blood pressure medication, and fenofibrate (Tricor), a triglyceride-lowering drug, also help reduce blood levels of uric acid. 

The doctor also recommend losing weight, for those who are overweight; limiting alcohol consumption; and avoiding or limiting high-purine foods, which can increase uric acid levels.


Lifestyle suggestions


If you are overweight, try to lose some weight. This can help to lower the uric acid (urate) level. However, do not use diets that increase uric acid levels, such as high-protein diets or starvation diets.

Eat sensibly. A high uric acid level may be lowered a bit by avoiding a high protein intake and foods rich in purines, such as liver, kidneys and seafood. Also avoid eating foods high in yeast extracts, such as Marmite®. See separate Gout Diet Sheet for more details.

Avoid alcohol 

Avoid sugar-sweetened soft drinks

If you are taking any medicines, check whether they are a cause of gout (see above). An alternative medicine may be available. Your doctor will advise.

Avoid lack of fluid in the body (dehydration) by drinking plenty of water (up to two litres per day unless there is a medical reason why not to).

Have your blood pressure checked at least once a year. High blood pressure is more common in people with gout.

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