Gout

Gout is a complex form of arthritis. Men are more likely to get gout, but women are prone after menopause.

Gout is characterized by sudden, severe attacks of pain, redness, swelling and tenderness in joints, often the joint at the base of the big toe-the metatarsophalangeal joint is involved. These attacks may happen over and again unless it is treated. Over time, they can harm the joints, tendons, and surrounding tissues.

Sudden attacks of gout can occur, often in the middle of the night with burning sensation around the big toe. The affected joint is red hot and tender.Range of motion is decreased, joint mobility may limit further as gout progresses.

Gout is treatable, frequency and intensity can be reduced by care and preventive measures.

Look for medical care immediately if there is fever with a hot and inflamed joint, this could be a sign of early infection.

The attacks can last a few days or weeks before the pain dissipates. Another attack may not happen for a long time. Big joints and other joints also can be involved.

Causes

Urate crystals accumulate in the joint, causing the inflammation and intense pain of a gouty attack. Urate crystals can form when high levels of uric acid is in the blood.

The body makes uric acid as purines found in the body break down along with other foods such as red meat and seafood. Other foods like alcoholic drinks and fruit sugar also promote higher uric acid.

Uric acid dissolves in blood and passes through kidneys into urine. But sometimes body either over produces uric acid or kidneys excrete too little uric acid. In these conditions uric acid can build up in blood, forming thin, sharp urate crystals in a joint or surrounding tissue that causes pain, swelling and inflammation.

Risk Factors

Hypertension, Diabetes, Obesity, Alcoholism, Metabolic conditions, Heart and Kidney diseases increase the risk, frequency and intensity of attacks. Family history of gout, recent trauma and surgery are also other factors.

Tests for confirming diagnosis

Blood uric acid levels, CRP, ESR and sample of fluid from the joint to see uric acid crystals. Blood counts, Blood Sugar should also be done in the acute stage. Urine test to see the presence of crystals and measure uric acid in a 24 hr. sample.

X-Rays to rule out other causes, reduced joint space in established gout signifies cartilage erosion and thinning. Ultrasound can identify urate crystals in a joint.

CT scan in chronic conditions with evidence of joint destruction.

Treatment

Avoid home remedies to save productive man hours and seek early management.

Treatment is for symptoms and not to treat higher uric acid level in blood if asymptomatic. This involves medications used to treat acute attacks and prevent future attacks as well as reduce the risk of complications of gout, such as the development of kidney stones and tophi from urate crystal deposits.

NSAIDS (Nonsteroidal anti-inflammatory drugs) include OTC (over-the-counter) drugs such as ibuprofen and naproxen sodium.

Prescription NSAID like celecoxib (Celebrex) and others are given after consultation and physical examination. Do not hesitate to see your Orthopaedic surgeon who may be the most appropriate to treat initially, physicians could be consulted later.

Doses are titrated with symptoms taking care to add antacids along with to control or avoid gastric symptoms followed by a lower daily Maintainence dose for prevention.

Colchicine (Colcrys, Mitigare), a pain reliever that effectively reduces gouty pain but has intolerable side effects like nausea, vomiting and diarrhea.

After an acute gout attack resolves,  a low daily dose of colchicine to prevent future attacks.

Corticosteroids like prednisone  for patients who can’t take either NSAIDs or colchicine may control gouty inflammation and pain. Corticosteroids may be administered in oral form, or can be injected into the joint occasionally. Side effects of corticosteroids may include increased blood sugar levels and elevated blood pressure.

Medications that clump uric acid production. Drugs called xanthine oxidase inhibitors, including allopurinol limit the amount of uric acid the body makes. This may lower the blood’s uric acid level and reduce the risk of gout. These are taken under guidance of the treating doctor.

Side effects of allopurinol include a rash and low blood counts. Febuxostat side effects include nausea, reduced liver function and drug rash.

Medication that improves uric acid removal. Probenecid improves your kidneys’ ability to remove uric acid from your body. This may lower your uric acid levels and reduce your risk of gout, but the level of uric acid in your urine is increased.

Side effects include a gastritis, kidney stones and drug rash.

Lifestyle modification and nutrition care are recommended.