Gout
What Is Gout?
Gout is one of the most painful rheumatic diseases. It
results from deposits of needle-like crystals of uric acid in connective
tissue, in the joint space between two bones, or in both. These deposits
lead to inflammatory arthritis, which causes swelling, redness, heat,
pain, and stiffness in the joints. The term arthritis refers to
more than 100 different rheumatic diseases that affect the joints,
muscles, and bones, as well as other tissues and structures. Gout
accounts for approximately 5 percent of all cases of arthritis.
Pseudogout is sometimes confused with gout because it
produces similar symptoms of inflammation. However, in this condition,
also called chondrocalcinosis, deposits are made up of calcium phosphate
crystals, not uric acid. Therefore, pseudogout is treated somewhat
differently and is not reviewed in this booklet.
Uric acid is a substance that results from the breakdown
of purines, which are part of all human tissue and are found in many
foods. Normally, uric acid is dissolved in the blood and passed through
the kidneys into the urine, where it is eliminated. If the body
increases its production of uric acid or if the kidneys do not eliminate
enough uric acid from the body, levels of it build up in the blood (a
condition called hyperuricemia). Hyperuricemia also may result when a
person eats too many high-purine foods, such as liver, dried beans and
peas, anchovies, and gravies. Hyperuricemia is not a disease and by
itself is not dangerous. However, if excess uric acid crystals form as a
result of hyperuricemia, gout can develop. The excess crystals build up
in the joint spaces, causing inflammation. Deposits of uric acid, called
tophi (singular: tophus), can appear as lumps under the skin around the
joints and at the rim of the ear. In addition, uric acid crystals can
collect in the kidneys and cause kidney stones.
For many people, gout initially affects the joints in
the big toe. Sometime during the course of the disease, gout will affect
the big toe in about 75 percent of patients. It also can affect the
instep, ankles, heels, knees, wrists, fingers, and elbows. The disease
can progress through four stages:
- Asymptomatic (without symptoms) hyperuricemia--In this
stage, a person has elevated levels of uric acid in the blood but no
other symptoms. A person in this stage does not usually require
treatment.
- Acute gout, or acute gouty arthritis--In this stage,
hyperuricemia has caused the deposit of uric acid crystals in joint
spaces. This leads to a sudden onset of intense pain and swelling in
the joints, which also may be warm and very tender. An acute attack
commonly occurs at night and can be triggered by stressful events,
alcohol or drugs, or the presence of another illness. Early attacks
usually subside within 3 to 10 days, even without treatment, and the
next attack may not occur for months or even years. Over time,
however, attacks can last longer and occur more frequently.
- Interval or intercritical gout--This is the period between
acute attacks. In this stage, a person does not have any symptoms and
has normal joint function.
- Chronic tophaceous gout--This is the most disabling stage
of gout and usually develops over a long period, such as 10 years. In
this stage, the disease has caused permanent damage to the affected
joints and sometimes to the kidneys. With proper treatment, most
people with gout do not progress to this advanced stage.
What Causes Gout?
A number of risk factors are related to the development
of hyperuricemia and gout:
- Genetics may play a role in determining a person's risk, since up
to 18 percent of people with gout have a family history of the
disease.
- Gender and age are related to the risk of developing gout; it is
more common in men than in women and more common in adults than in
children.
- Being overweight increases the risk of developing hyperuricemia
and gout because there is more tissue available for turnover or
breakdown, which leads to excess uric acid production.
- Drinking too much alcohol can lead to hyperuricemia because it
interferes with the removal of uric acid from the body.
- Eating too many foods rich in purines can cause or aggravate gout
in some people.
- An enzyme defect that interferes with the way the body breaks down
purines causes gout in a small number of people, many of whom have a
family history of gout.
- Exposure to lead in the environment can cause gout.
Some people who take certain medicines or have certain
conditions are at risk for having high levels of uric acid in their body
fluids. For example, the following types of medicines can lead to
hyperuricemia because they reduce the body's ability to remove uric
acid:
- Diuretics, which are taken to eliminate excess fluid from the body
in conditions like hypertension, Oedema, and heart disease, and which
decrease the amount of uric acid passed in the urine;
- Salicylates, or anti-inflammatory medicines made from salicylic
acid, such as aspirin;
- The vitamin niacin, also called nicotinic acid;
- Cyclosporine, a medicine used to suppress the body's immune system
(the system that protects the body from infection and disease) and
control the body's rejection of transplanted organs; and
- Levodopa, a medicine used to support communication along nerve
pathways in the treatment of Parkinson's disease
How Is Gout Diagnosed?
Gout may be difficult for doctors to diagnose because
the symptoms may be vague, and they often mimic other conditions.
Although most people with gout have hyperuricemia at some time during
the course of their disease, it may not be present during an acute
attack. In addition, having hyperuricemia alone does not mean that a
person will get gout. In fact, most people with hyperuricemia do not
develop the disease.
To confirm a diagnosis of gout, a doctor may insert a
needle into an inflamed joint and draw a sample of synovial fluid, the
substance that lubricates a joint. A laboratory technician places some
of the fluid on a slide and looks for monosodium urate crystals under
a microscope. Their absence, however, does not completely rule out the
diagnosis. The doctor also may find it helpful to examine chalky,
sodium urate deposits (tophi) around joints to diagnose gout. Gout
attacks may mimic joint infections, and a doctor who suspects a joint
infection (rather than gout) may check for the presence of bacteria.
Signs and Symptoms of Gout
- Hyperuricemia
- Presence of uric acid crystals in joint fluid
- More than one attack of acute arthritis
- Arthritis that develops in 1 day, producing a swollen, red, and
warm joint
- Attack of arthritis in only one joint, usually the toe, ankle,
or knee
How Is Gout Treated?
With proper treatment, most people with 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 both the discomfort caused by the
symptoms of gout and long-term damage of the affected joints.
Treatment will help to prevent disability due to gout.
Preventing acute gout attacks is equally as important
as treating the acute arthritis. Prevention of acute gout involves
maintaining adequate fluid intake, weight reduction, dietary changes,
reduction in alcohol consumption, and medications to reduce
hyperuricemia.
Using magnetic
therapy will reduce the pain, inflammation and swelling associated with
gout.Magnets
alleviate pain, increase blood circulation and speed up the healing
process by reducing inflammation in the body.
They can be applied in the forms of magnetic straps/ wraps, pillows,
jewellery, mattress covers and water
Maintaining adequate fluid intake helps prevent acute gout attacks.
Adequate fluid intake also decreases the risk of kidney stone
formation in patients with gout. Alcohol is known to have diuretic
effects which can contribute to dehydration and precipitate acute gout
attacks. Alcohol can also affect uric acid metabolism and cause
hyperuricemia.
Dietary changes can help reduce uric acid levels in the blood. Since
purine chemicals are converted by the body into uric acid, purine rich
foods are avoided. Examples of foods rich in purine include shellfish
and organ meats, such as liver, brains, kidneys, and sweetbreads.
Weight reduction can be helpful in lowering the risk of recurrent
attacks of gout. This is best accomplished by reducing dietary fat and
calorie intake, combined with a regular aerobic exercise program
The
most common treatments for an acute attack of gout are high doses of
non steroidal 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. Corticosteroids are strong
anti-inflammatory hormones. The most commonly prescribed
corticosteroid is prednisone. Patients often begin to improve within a
few hours of treatment with a corticosteroid, and the attack usually
goes away completely within a week or so.
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