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Gout

 
General Info

The word Gout is from Latin and it means drop. Known as "the disease of kings and the king of diseases," gout has been studied by physicians and has caused suffering in countless humans at least since the days of Hippocrates.
 
Gout afflicts an estimated 840 out of 100,000 people. Gout is strongly associated with obesity, hypertension, hyperlipidemia and diabetes. Gout is a condition with abnormally high levels of uric acid in the blood. It is characterized by recurring attacks of joint inflammation (arthritis), deposits of hard lumps of uric acid in and around the joints and decreased kidney function and kidney stones.
 
The joint inflammation is caused by deposits of uric acid crystals in the joint fluid (synovial fluid) and joint lining (synovial lining). Intense joint inflammation occurs when the white blood cells engulf the uric acid crystals, causing pain, heat and redness of the joint tissues.

 
Causes
 
Gout is caused by a defect in metabolism that results in an overproduction of uric acid, or a reduced ability of the kidney to eliminate uric acid. The exact cause of the metabolic defect is unknown. The disorder causes painful arthritis, especially in the joints of the feet and legs. The condition may also develop in people with diabetes mellitus, obesity, sickle cell anemia, and kidney disease, or it may follow drug therapy that interferes with uric acid excretion. Certain drugs, can also cause gout. Certain diseases such as leukemia and hemoglobin disorders lead to excessive production of uric acid in the body.
 
Symptoms
 

Gout develops in a person gradually or suddenly with severe symptoms. Symptoms develop suddenly and usually involve only one or a few joints. The pain frequently starts during the night and is often described as throbbing, crushing, or excruciating. Excruciating pain in the "Big Toe" in the recent past may indicate Gout.
 
The affected joint appears warm, red, and tender. The pain at the joints may subside in several days, but may recur at irregular intervals. Subsequent attacks usually have a longer duration.
 
In some people, it may progress to chronic gouty arthritis, while others may have no further attacks. 
 
Who are at more of getting gout?
 
Men, postmenopausal women, people with kidney disease, diabetes mellitus, sickle cell anemia, or obesity have higher chances of getting Gout.

 
Diagnosis
 

Physical examination of the joints shows swelling, redness and warmth.

Joint fluid analysis shows uric acid crystals.
Uric acid (in blood test) may be elevated above 7.5 mg/dl.
Joint X-rays may be normal. 
 
Treatment
 

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.
 
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.
 
There are three aspects to the medication treatment of gout. First, pain relievers such as acetaminophen/Tylenol or other more potent analgesics are used to manage pain. Secondly, anti-inflammatory agents such as nonsteroidal anti-inflammatory drugs (NSAIDS), colchicine, and corticosteroids are used to decrease joint inflammation. Finally, medications are considered for managing the underlying metabolic derangement that causes hyperuricemia and gout. This means treating the elevated levels of uric acid in the blood with medications that reduce these levels.

 
More Info
 

Gout is more common in men than women.

What to do, if you have gout?
Avoid alcohol. It increases uric acid accumulation.
Reduce intake of roasted food and food without Vitamin E. . . Lack of
   Vitamin E has been linked with a rise in uric acid.
Drink plenty of water.
Eat raw fruits, vegetables, grains, seeds and nuts.
Avoid eating meat as it is rich in uric acid forming components.

 
FAQ
 

Is Gout curable?
 
It cannot be completely cured. But it can be prevented by administering medication which can prevent further damage. 

Who can get gout?
  
If you eat a lot of foods that are rich in purines, you may get gout. Some of these foods are salmon, sardines, liver and herring. You may get gout if you’re overweight, drink alcohol or have high cholesterol. Men have gout more often than women do. Women are more likely to have gout after menopause. 
Some medicines may cause gout, such as certain diuretics (“water pills”), niacin (a B-complex vitamin), aspirin (taken in low doses), and some drugs used to treat cancer. 

During an acute gout attack what should I do and what drugs should I be taking?
 
Change your diet plan. Avoid the intake of red meats, shellfish, beer, red wine and salt. 
First, pain relievers such as acetaminophen/Tylenol or other more potent analgesics are used to manage pain. 
Secondly, anti-inflammatory agents such as nonsteroidal anti-inflammatory drugs (NSAIDS), colchicine, and corticosteroids are used to decrease joint inflammation.
 
What are the side effects of NSAID group of drugs?
 
Common side effects of NSAIDS include irritation of the gastrointestinal system, ulceration of the stomach and intestines, and even intestinal bleeding. Patients who have a history of allergy to aspirin or nasal polyps should avoid NSAIDS because of the risk of an intense allergic (anaphylactic) reaction. 

What are the precautions to be taken with NSAID group of drugs?
 
Always take the medication after food or with a glass of milk.

 
Glossary
 
Arthritis: Inflammation of tissues in the joints. 
Metabolism: A bio-chemical process through which energy consumption and energy production is carried out in cells. 
Uric Acid: White crystals of water soluble lithic acid found in urine. 
Synovial Fluid: This is a clear fluid found in the joints, acting as a lubricant. The synovial fluid fills the synovium, the membrane that surrounds a joint and creates a protective sac. In addition to cushioning joints, this fluid supplies nutrients and oxygen to cartilage, the slippery tissue that coats the ends of bones. 
Sickle Cell Anemia: A condition in which the red blood cells appear in a sickle or crescent shape preventing the normal functioning of red blood cells thus causing anemia.
Renal Calculi : Uric acid kidney stones.

 
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