Dr Dulcy grapples with gout
GOUT: SYMPTOMS CAN OCCUR WITHOUT ANY WARNING
Meat, alcohol the cause of high uric acid levels in your joints.
Gout is a type of arthritis (joint inflammation) that can affect anyone. The usual symptoms are sudden burning pain, stiffness, and swelling in a joint, usually a big toe. These attacks can happen over and over unless gout is treated. Over time, these attacks can lead to damage to your joints, tendons, and other tissues.
Men are more likely to get gout, but women become increasingly susceptible to gout after menopause. An attack of gout can occur suddenly, often waking you up in the middle of the night with the sensation that your big toe is on fire.
The affected joint is hot, swollen and so tender that even the weight of the sheet on it may seem intolerable. It is a treatable disease and there are ways to make sure it does not recur.
Signs And Symptoms
The signs and symptoms of gout almost always occur suddenly, often at night and without warning. They include: Severe joint pain. Gout usually affects the large joint of your big toe, but it can occur in your feet, ankles, knees, hands and wrists. The pain is likely to be most severe within the first four to 12 hours after it begins. Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints. Inflammation and redness. The affected joint or joints become swollen, tender, warm and red. Limited range of motion. Decreased joint mobility may occur as gout progresses.
Causes
With gout, uric acid crystals accumulate in your joint, causing inflammation and intense pain. Uric acid crystals form when you have high levels of uric acid in your blood. Your body produces uric acid when it breaks down purines, substances that are found naturally in your body, and in certain foods, such as steak, organ meats and seafood. Other foods also promote higher levels of uric acid, such as alcohol, especially beer, and drinks sweetened with fructose. Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes your body either produces too much uric acid or your kidneys excrete too little. When this happens, uric acid can build up, forming sharp, needle-like urate crystals in a joint or tissue that cause pain, inflammation and swelling.
Risk Factors
These are factors that increase the uric acid level in your body and they include:
Diet. Eating a diet that’s high in meat and seafood and high in beverages sweetened with fructose promotes higher levels of uric acid, which increases your risk of gout. Alcohol consumption also increases the risk of gout.
Obesity. If you are overweight, your body produces more uric acid and your kidneys have a more difficult time eliminating it, which greatly increases your risk of gout.
Medical conditions. Certain diseases and conditions make it more likely that you’ll develop gout. These include untreated high blood pressure and chronic conditions such as diabetes, metabolic syndrome, and heart and kidney diseases.
Certain medications. The use of thiazide diuretics (amiloretic, ridaq) commonly used to treat hypertension and low-dose aspirin also can increase uric acid levels. So can the use of anti-rejection
drugs prescribed for people who have undergone an organ transplant.
Family history of gout. If other members of your family have had gout, you’re more likely to develop the disease.
Age and sex. Gout occurs more often in men, primarily because women tend to have lower uric acid levels. After menopause, however, women’s uric acid levels approach those of men.
Recent surgery or trauma. Experiencing recent surgery or trauma has been associated with an increased risk of developing gout.
Complications
People with gout can develop more-severe conditions, such as:
Recurrent gout. Some people may experience gout attacks several times each year. Medications may help prevent gout attacks in people with recurrent gout. If left untreated, gout can cause erosion and destruction of a joint.
Advanced gout. Untreated gout may cause deposits of urate crystals to form under the skin in nodules or lumps called tophi. Tophi can develop in several areas such as your fingers, hands, feet, elbows or Achilles tendons along the backs of your ankles. Tophi usually aren’t painful, but they can become swollen and tender during gout attacks.
Kidney stones. Urate crystals may collect in the urinary tract of people with gout, causing kidney stones. Medications can help reduce the risk of kidney stones.
Diagnosis
Tests to help diagnose gout may include:
Joint fluid test. Your doctor may use a needle to draw fluid from your affected joint. When examined under the microscope, your joint fluid may reveal urate crystals.
Blood test. A blood test to measure the levels of uric acid and creatinine in your blood. However blood test results can be misleading. Some people have high uric acid levels, but never experience gout. And some people have signs and symptoms of gout, but don’t have unusual levels of uric acid in their blood.
X-ray imaging. Joint X-rays can be helpful to rule out other causes of joint inflammation.
Ultrasound. Musculoskeletal ultrasound can detect urate crystals in a joint or in a tophus.
Dual energy CT scan. This type of imaging can detect the presence of urate crystals in a joint, even when it is not acutely inflamed. This test is not used routinely in clinical practice because it is expensive and is not widely available.
Treatment
Gout medications can be used to treat acute attacks and prevent future attacks as well as reduce your risk of complications from gout, such as the development of tophi from urate crystal deposits. Drugs used to treat acute attacks and prevent future attacks include:
Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include over-the-counter options such as ibuprofen and naproxen sodium, as well as more-powerful prescription NSAIDs such as indomethacin or celebrex. Your doctor may prescribe a higher dose to stop an acute attack, followed by a lower daily dose to prevent future attacks. NSAIDs however carry risks of stomach pain, bleeding and ulcers.
Colchicine. Your doctor may recommend Colchicine, a type of pain reliever that effectively reduces gout pain. The drug’s effectiveness is offset in most cases, however, by intolerable side-effects, such as nausea, vomiting and diarrhoea. After an acute gout attack resolves, your doctor may prescribe a low daily dose of Colchicine to prevent future attacks.
Corticosteroids. Corticosteroid medications, such as the drug prednisone, may control gout inflammation and pain. Corticosteroids may be administered in pill form, or they can be injected into your joint. Corticosteroids are generally reserved for people who can't take either NSAIDs or colchicine. Side effects of corticosteroids may include mood changes, increased blood sugar levels and elevated blood pressure.
Lifestyle Choices/Prevention
Keep your fluid intake high. Stay well-hydrated, including plenty of water. Stay away from sweetened beverages, especially those sweetened with high fructose corn syrup.
Limit or avoid alcohol. Talk with your doctor about whether any amount or type of alcohol is safe for you. Recent evidence suggests that beer may be particularly likely to increase the risk of gout symptoms, especially in men.
Get your protein from other sources. Examples are vegetable proteins like beans and tofu.
Limit your intake of meat, fish and poultry. A small amount may be tolerable, but pay close attention to what types and how much seem to cause problems for you.
Maintain a desirable body weight. Choose portions that allow you to maintain a healthy weight. Losing weight may decrease uric acid levels in your body.
But avoid fasting or rapid weight loss, since doing so may temporarily raise uric acid levels.