Gout

What is Gout?

Gout is characterized by sudden, severe attacks of pain, swelling, redness and tenderness in the joints, often the joint at the base of the big toe. This condition is a common and complex form of arthritis that can affect anyone.

Gout attacks suddenly often occurring in the middle of the night with the sensation that the big toe is on fire. The affected joint feels hot, swollen and very painful.Hypertension, cardiovascular, and obesity are risk factors for gout.

Causes of Gout

Gout occurs when there is an inflammation and intense pain in the joints, it occurs when Urate crystals accumulate in the joint. Urate crystals form out of high levels of uric acid in the blood. The body produces uric acid when purines (substances that are found naturally in your body)are broken down.

Purines can also be found in steak, organ meats and seafood. There are other foods, such as alcoholic beverages, especially beer, and drinks sweetened with fructose that also promote higher levels of uric acid.

Normally, uric acid dissolves in blood and passes through the kidneys into the urine. However at a point, the body either produces too much uric acid or the kidneys excrete too little uric acid. When this happens, uric acid builds up, and forms sharp, needlelike Urate crystals in a joint or surrounding tissue that causes pain, inflammation and swelling.

Symptoms of Gout

The signs and symptoms of this condition almost always occur at night without warning.

They may include:

• Inflammation and redness - The affected joint or joints become swollen, tender, warm and red.
• Intense joint pain– Although it can occur in any joint, gout usually affects the large joint of the big toe. Other commonly affected joints may include the ankles, knees, elbows, wrists and fingers. The pain is usually most severe within the first four to 12 hours after it begins.
• Limited range of motion - Gout may render one not being able to move their joints normally.
• Lingering discomfort - Discomfort in the jointslasting from a few days to a few weeks may occur after the most severe pain subsides.

Later attacks are most likely to last longer and affect more joints.

Risk Factors

Gout develops in the event of a buildup of uric acid.

Factors that contribute to the increase the uric acid level may include:

• Diet- Eating large amounts of meat and seafood. Drinking beverages sweetened with fruit fructose (sugar) may lead to increased levels of uric acid. Alcohol, especially the consumption of beer, also increases the risk of gout.
• Family history of the condition – One is more likely to develop this condition if other family members have had gout in the past.
• Age and Gender - Because women naturally have lower uric acid levels, gout occurs more often in men.After menopause however, women's uric acid levels approach those of men. Men are therefore more likely to develop gout earlier, whereas women generally develop signs and symptoms after menopause.
• Use of certain medications - Thiazide diuretics which is commonly used to treat hypertension and low-doses of aspirin also can increase uric acid levels.
• Obesity– An overweight body produces more uric acid and makes the kidneys have a difficult time eliminating the acid.
• Medical conditions - Certain diseases and conditions like untreated high blood pressure and chronic conditions such as diabetes, metabolic syndrome, and heart and kidney diseases may increase the risk levels of gout.

Complications

Gout can develop into more-severe conditions, such as the following:

• Recurrent gout - If left untreated, gout can cause the erosion and complete destruction of a joint. Some individuals may never experience gout signs and symptoms beyond the first attack. Others may experience the condition several times each year. Medications may help prevent recurrent attacks ofthe condition.
• Advanced gout - If left untreated,the condition may cause deposits of Urate crystals to form under the skin. This can develop in areas such as your fingers, hands, feet, elbows or Achilles tendons along the backs of your ankles. Commonly referred to as Tophi, it usually isn’t painful, but they swell up and become tender during attacks of gout.
• Kidney stones – in some cases, Urate crystals collect in the urinary tract of gout patients, causing kidney stones.

Diagnosis for Gout

Tests to help diagnose gout may include:

• Joint fluid test: Our doctors' may use a needle to draw fluid from your affected joint. Urate crystals may be visible when the fluid is examined under a microscope.
• Blood test: Our doctors' may recommend a blood test to measure the levels of uric acid and creatinine in your blood. Blood test results can be misleading, though. 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. This technique is more widely used in Europe than in the United States.
• 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 due to the expense and is not widely available.

Treatment for Gout at Diamed

Includes combination of physical therapy and herbal medicine, and changes and control diet with low quantities of purines.

Usually, treatment for gout involves mostly medications. A patient’s existing health condition would determine the medications the doctor chooses. These medications can be used to treat acute attacks as well as prevent future attacks.

Usually medical doctors prescribe the drugs used to treat and prevent Gout attacks include:

• Non-steroidal anti-inflammatory (NSAIDs) – These will include Ibuprofen, Motrin, Advil etc. which can be bought over the counter, as well as Indocin or Celebrex which are more-powerful but are prescription NSAIDs.

NOTE: NSAIDs carry risks of stomach pain, bleeding and ulcers.

• Corticosteroids – This may be in the form of a pill or they can be injected into the joint. Corticosteroid medications e.g. Prednisone, could be effective in the control of gout inflammation and pain.It is generally used in cases in which patients can't take neither NSAIDs nor Colchicine.

NOTE: Known side effects of Corticosteroids may include increased blood sugar levels, mood changes, and elevated blood pressure.

• Colchicine - A doctor may recommend this pain reliever which is very effective in reducing gout pain, but doesn’t treat it. A low daily dose of Colchicine could be prescribed to prevent future attacks but can cause the addiction. After an acute gout attack is resolved.

NOTE: The drug's effectiveness may not be in question, however, it has side effects such as nausea, vomiting and diarrhea, kidney disease especially if taken in large doses.

Alternative Medicine

Individuals can manage Gout flare-ups through diet moderation. A balanced diet can help reduce symptoms.

It will be reasonable to reduce foods that are high in purines, this will be to control the levels of uric acid in the blood so it does not get too high.

The following is a list of high-purine foods to be wary of:

• Dried beans and peas
• Bush meats
• Sardines, mackerel, herring
• Shrimps, prongs, crabs
• Mushrooms
• Scallops
• Gravy
• Liquors
• Sweeteners
• Liver
• Chicken thigh
• Animal organs
• Spinach
• Cauliflower
• Soft drinks with gas
• Hard cheese

It makes reasonable sense to decrease or avoid these foods, however studies reveal that a high purine-rich diet does not necessarily aggravate symptoms or increase the risk of gout. Red meat, fructose-containing beverages, and alcohol can increase the risk.

The role of uric acid in gout has been clearly defined and understood. Gout is a very controllable form of arthritis.

Prevention for Gout

These guidelines may help protectagainst future attacks of gout:

• Drink plenty of fluids - One must stay well-hydrated, drinking plenty of water and limiting the amount of sweetened beverages.
• Avoid or limit alcohol consumption – Discuss with your doctor about what amount or type of alcohol is safe for you. Recently adduced evidence suggests that beer in particular is likely to increase the risk of gout symptoms in men.
• Eat low-fat dairy products - This may actually have a protective effect against gout, so they are your bestsources of protein.
• Meat, fish and poultry must be limited - A small amount of each may be tolerable, but pay close attention to what seems to cause problems for you most.
• Check obesity – Maintain a healthy weight. Losing weight may decrease uric acid levels in the body. One must choose diets that allow forthe maintenance of a healthy weight. In doing that, beware of rapid weight loss, doing that may temporarily raise uric acid levels.

Medications for prevention

A doctor may recommend medication to reduce the risk of gout-related complications. This could bewhen a patient experiences several gout attacks in a year, or if the gout attacks are not frequent but particularly painful.

In some cases, medications to lower the body's level of uric acid may be recommended.

Options include:

• Medications that block production ofuric acid - Xanthine oxidase inhibitors (XOIs), such as Allopurinol e.g. (Aloprim, or Zyloprim) and Febuxostat e.g. (Uloric). These drugs limit the amount of uric acid the body makes. The aim is to lower the blood's uric acid level and reduce the risk of gout.

NOTE: XOIs have some notable side effects.Febuxostat has Rash, nausea, reduced liver function and an increased risk of heart-related problems asside effects. Allopurinol’sside effects may include a rash and low blood counts.

• Medication that improves theremoval of uric acid - These are drugs commonly called Uricosurics, may include Probenecide.g. (Probalan) and Lesinurad e.g. (Zurampic). They improve the kidneys' ability to remove uric acid from the body. Thus effectively lowering uric acid levels and reduce the risk of gout. However, the level of uric acid in the urine will increase as a result.

NOTE: Side effects of Uricosurics may include a rash, stomach pain and kidney stones. Lesinurad is a special case. It can be taken only along with an XOI.