GOUT

INTRODUCTION

Gout is a type of arthritis (inflammation of the joints). It causes painful swelling and inflammation in one or more of the joints, and commonly affects the big toe and knee, although it may develop elsewhere, in any joint of the body.

Gout is caused by uric acid build-up in the body. Uric acid is a waste product which results from metabolism of proteins in the body. Under normal circumstances uric acid is eliminated via the kidneys. In people where this mechanism of waste elimination from the kidneys is affected, or in people who produce too much uric acid, gout results because of crystal formation in the joints. These crystals are the cause of pain and swelling.

Gout mainly affects men, and is less common in women. It peaks between the ages of 40-60 years.

RISK FACTORS FOR GOUT:

Risk factors include:

increased intake of alcohol

Diet rich in protein, especially protein with a high purine content ( red meat and sea food)

SIGNS AND SYMPTOMS

Symptoms of gout develop rapidly and last for 7-10 days. The hallmark symptom is an acutely swollen and painful joint (most commonly the big toe). It often comes on suddenly during the night, although that is not the only time of the day when a gout attack might occur.

Other symptoms include:

red, shiny skin over the joint

itching and flaking of skin over the affected joint

swelling,

fever, which is usually low grade

DIAGNOSIS AND MANAGEMENT

Gout is diagnosed after a complete history is taken and physical exam is performed. There is no particular diagnostic test to diagnose it. Gout is one of the over 200 forms of joint pathology. Serum uric acid may be carried out a few weeks after a gout attack (levels of uric acid are elevated a few weeks after an attack, not immediately). If there is doubt about the diagnosis, some fluid may be drawn from your knee to do a microscopic test for further confirmation.

During a gout attack, it is important to rest, elevate (raise) your limb and avoid accidentally knocking or damaging the affected joint.

Keeping the affected joint cool should help improve your symptoms.

Medication

Non-steroidal anti-inflammatory drugs (NSAIDs) are a type of painkiller usually recommended as an initial treatment to relieve the symptoms of gout. NSAIDs work by reducing the levels of pain and inflammation.

NSAIDs must be avoided in people with reduced kidney function and only used with great care under medical direction in patients who have had problems with indigestion, stomach ulcers or bleeding.

Colchicine

If you are unable or do not want to take NSAIDs, or if NSAIDs are ineffective at treating your symptoms, colchicine can be used instead. Colchicine works by interfering with the uric acid crystals to reduce inflammation.

Colchicine can be very poisonous if it is taken in too high a dose. It is very important to follow the recommended dosage schedule. For most people, this means taking two to four tablets a day.

Steroids may also be sometimes to alleviate particularly severe attacks of gout. They can not be used for long periods of time, however.

Dr. Annie

Physician, mom and wife

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