Gout
Definition
Gout, also called crystal-induced arthritis, is an arthritic condition that occurs when uric acid crystals accumulate in the joints. Gout usually affects the large joint of the big toe, but can also affect other joints, such as the knee, ankle, foot, hand, wrist and elbow. In rare cases, it may later affect the shoulders, hips or spine. Gout does not spread from joint to joint.
Description
Uric acid is a substance that normally forms when the body breaks down waste products (called purines). Uric acid is usually dissolved in the blood and passes through the kidneys into the urine. For people with gout, the uric acid level in the blood is so high that uric acid crystals form and deposit in joints and other tissues. This causes the joint lining to become inflamed, resulting in sudden and severe attacks of pain, tenderness, redness and warmth. After several years, the crystals can build up in the joints and surrounding tissues, forming large deposits, called tophi. Tophi look like lumps under the skin and are often found in or near severely affected joints, on or near the elbow, over the fingers and toes, and in the outer edge of the ear. Another condition, called pseudogout, is caused by deposits of calcium-based (instead of urate-based) crystals in the joints.
Causes
In about 90 percent of all cases, gout is prevalent in men older than 40 and in menopausal women. An "episode" often occurs overnight, and within 12 to 24 hours, there is severe pain and swelling in the affected joint. The episode usually lasts about five to 10 days. Although the exact cause is unknown, gout may be caused by:
- genetic defect in metabolism, which causes overproduction and retention of uric acid
- kidney impairment that prevents normal elimination of uric acid
- thiazide diuretic medications (water pills) used to treat high blood pressure and heart failure
- diseases of the blood cells and blood-forming organs, certain cancers and psoriasis
- environmental factors, such as obesity, alcohol abuse and a purine-rich diet.
An episode of gout can be triggered by:
- drinking too much alcohol
- eating too much of the wrong foods
- surgery
- sudden, severe illness
- crash diets
- injury to a joint
- chemotherapy.
Symptoms
Gout generally occurs in four (4) stages (asymptomatic, acute, intercritical and chronic) and has the following signs and symptoms: Asymptomatic stage - urate levels rise in the blood, but produces no symptoms Acute stage - symptoms usually lasting five to 10 days
- sudden attack of joint pain
- swelling
- joints feel hot, tender and look dusty red or bruised
Intercritical stage - symptom-free intervals between gout episodes. Most people have a second attack from six months to two years, while others are symptom-free for five to 10 years. Chronic stage
- persistently painful joints with large urate deposits in the cartilage, membranes between the bones, tendons and soft tissues
- skin over the deposits develop sores and release a white pus
- joint stiffness
- limited motion of affect joint
Diagnosis
The diagnosis of gout is based on symptoms, blood tests showing high levels of uric acid, and the finding of urate crystals in joint fluid. In chronic gout, x-rays show damage to the cartilage and bones.
Treatment
Currently, there is no cure for gout, but through proper diet, a healthy lifestyle and medications, the symptoms of gout can be relieved and further episodes eliminated. Proper diet
- Avoid or restrict foods high in purine (a substance that produces uric acid when broken down). These foods include: sardines, anchovies, brains, liver, kidneys, tripe, sweetbreads, tongue, shellfish (mussels and oysters), fish roe, scallops, peas, lentils, beans and an excessive amount of red meat.
- Drink 10 to 12 eight-ounce glasses of non-alcoholic fluids daily.
Healthy lifestyle
- Reduce alcohol consumption
- Lose weight
Medications Using medications for gout can be complicated, because the treatment needs to be tailored for each person and may need to be changed from time to time. To relieve the pain and swelling of an acute attack, the doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, corticosteroid drugs, and/or adrenocorticotropic hormone (ACTH). To prevent future attacks, the doctor may recommend colchicine, probenecid (Benemid, Parbenem or Probalan), sulfinpyrazone (Anturane), or allopurinol (Lopurin, Zurinol or Zyloprim). To prevent or treat tophi, probenecid, sulfinpyrazone and allopurinol are recommended. All of these drugs are powerful, so the patient needs to understand why they are taking them, what side effects may occur and what to do if they have problems with the medication.
Prevention
To lower risk factors, consider:
- supervised weight-loss program with exercise (if the patient is overweight)
- avoiding a purine-rich diet
- avoiding alcohol consumption, especially binge drinking
- changing to another drug, if taking diuretics for hypertension
Questions
What tests are needed to distinguish gout from other diseases? Can gout affect more than one joint at a time? Can it spread from one joint to the next? What is causing this disease? Has any permanent damage been done? What type of treatment will you be recommending? Will you be prescribing any medication? What are the side effects? Will you be recommending a nutritionist or a weight loss program?
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