Gout - Gouty Arthritis

Gout:

Gout is a medical condition, a metabolic disease in which crystals of Uric acid (Monosodium urate) gets deposited in joints and tissues. These crystals are the by-product of body’s Protein degradation.

Causes:

The proteins that we consume in our diet get digested and undergo various steps of degradation in our body. Uric acid is produced during this process is usually excreted from intestine and kidneys.

High levels of Uric acid can be produced due to

Intake of protein rich diet- high purine dietAbnormalities in chemical pathways that leads to excessive production of uric acidCertain drugs like Aspirin (Salicylates), Diuretics (Kidney drugs) interfere with the excretion of uric acid thereby raising its level in blood.

The body’s own overproduction of uric acid is an inherited condition and is present from birth.

Symptoms :

Uric acid is deposited in the form of crystals (Monosodium urate) in joints and tendon. This result in intense irritation, inflammation and pain in the joints and tendon tissues. The joint becomes hot, red and swollen.

Classically the big toe joint of the foot is affected, but ankles, knees, elbows and joints of hand and feet can be involved. Large joints like hip and shoulder joints tend to be spared.

Predisposing factors:

Men are more likely to be affected than women.The commonest age for the first attack is between 30 and 60.

Risk factors include.

A high alcohol intake. Alcohol by itself  does not cause gout, but it will stimulate gout attacks in those who are affectedA protein rich diet.Certain races, like Maoris and Polynesian- who have higher blood levels of uric acid are more susceptible to goutObesity,Conditions that cause high cell turnover, such as polycythaemia (increased red cells), lymphomas and various other cancers can increase blood uric acid levels.A family history of gout,Drugs like Diuretics (drugs increasing urine flow) or low dose salicylates,Kidney diseases,

Some percentage of patients suffering from Gout can have renal colic due to deposition on uric acid crystals in the kidneys.

Diagnosis:

History and complaints

Sudden onset of severe pain, swelling and redness of joint in great to of the foot.Sometimes swelling of joints of foot, ankles and handsHistory of similar episodes in the past.

Examination:

Red, tender, swelling of joint of great toe or other involved joints.Long standing cases uric acid crystals deposit in tendons, tissues appear as swellings called Gout tophi. More common around the elbow, wrists, finger and toe joints and sometimes on the earlobe.

Investigations:

Blood tests: Raised blood uric acid levelsDoubtful cases: Fluid examination from Gout swelling for Uric acid crystals.X rays: in long standing cases shows joint destruction

Treatment:

Acute attack:

Acute attack of gout is characterised by hot, swollen, red and painful joint of great to of foot.

Non-steroidal anti-inflammatory drugs in acute attacks help in reducing the pain and swelling. They should be given in high doses initially.Colchicine is one of the oldest known drugs and can be taken during acute painful phase.New drugs are available that can be given during acute attacks which can reduce blood levels of Uric acid.

Drug treatment:

Drugs in the treatment of gout are given to control the levels of uric acid in blood and to prevent long term complications. Drug dosage should be adjusted according to the levels of uric acid in the blood.

Allopurinol is one of the oldest and common drug used to control the levels of uric acid in blood. This drug inhibits xanthine oxidase which converts xanthine into uric acid.Probenicid and Sulphinpyrazone – Promotes excretion of uric acid through kidneys.

Prevention:

Once you are diagnosed with Gout, you’re a patient of gout for your life.

Avoid Protein rich diet – High Purine foodsAvoid Dehydration: especially in hot weathersAvoid unaccustomed strenuous exercise.Care should be taken in patients on long term diuretics and low dose aspirin.

Regular medications to control the uric acid levels by the advice of physician or orthopedician.

Complications of untreated Gout:

Long term complications of uncontrolled gout can cause

Joint damage (Arthritis),Formation of gout tophi (swellings around the joint) andRare complication of chronic kidney disease.