Epiglottitis

Gout is a disease which involves small joints and presents as pain and swelling. Gout results from overload of uric acid crystals which are formed and deposited in different tissues of joints. This leads to inflammation and Gouty Attacks. This is a recurrent and progressive process, which leads to joint destruction. Gout can also affect kidney functions because of the formation of uric acid stones in kidneys also called Nephrolithiasis.

Causes    :   

Gout is caused by inherent abnormality of the body to process uric acid. Uric Acid is a product of protein break down. Uric Acid Crystals are formed and deposited in and around joints - joint linings or syanovial membranes and joint fluids. This causes inflammation and severe pain and swelling of joints. As Gout progresses attacks occur more frequently leading to joint destruction.

There  are many risk factors/ causes such as :-

§ Obesity - Excessive weight gain   

§ Moderate to heavy Alcohol (Alcohol causes diuresis leading to dehydration, Alcohol also causes hyperuricemia (abnormally high level of uric acid in the blood))

§ High Blood Pressure

§ Kidney Dysfunction           

§ Chronic intake of medications such as Thyazide, low dose Aspirin, Niacin, Cyclosporin         

§ Diseases such as Leukemia, Lymphoma, Hemoglobin disorders

§ Hypothyroidism  

Conditions precipitating attacks are dehydration, Fever, Excessive Sweating, Alcohol, and recent surgery.   

Signs and Symptoms   : 

Pain and Swelling of small joints especially big toe are the main symptoms. Redness and Warmth, excessive tenderness and fever may be present. Attacks subside in hours to-days with or without treatment. Bursitis (Inflammation of joint coverings) may be seen.  Small nodular masses or Uric Acids crystals or Trophi may be deposited anywhere in the body including vocal cords and spine. 

Diagnosis:        History – Sudden onset of pain

                          Physical Examination – Joint Swelling and tenderness

                          Blood Test – To check increased Uric acid levels acid levels 

                          X ray – Bone damage may be present

                          Aspiration of Joint fluid – Aspirate may show Uric Acid Crystals under Polarizing microscope.   

Treatment:   

Goals of Treatment are to stop the acute attack and prevent further attacks. Elevation of the affected extremity (part) and hydration helps during the attacks.

• Fluid intake should be adequate to prevent crystallization of Uric Acid.

•  Acetaminophen is used to reduce the pain. 

• Non steroidal anti-inflammatory drugs such as colchicines reduce the inflammation.

•  Short term steroids may be helpful in the acute stage. 

•   Medications to reduce the Uric Acid Levels such as Allopurinol and Febuxostat may be used.

• Chronic Medications are used to reduce Uric Acid. There are two ways to do this,

Ø Drugs to increase kidney excretion of Uric acids are Probenezid and sulfinpyrzone.

Ø Drugs to decrease the production of Uric Acid such a Allopurinol and Febuxostat.             

 Intravenous medications such as Krystexxa is used in resistant cases. 

Prevention :      

Dietary changes may help to reduce the frequency of attacks. Uric Acid is a product of Purine metabolism, so avoiding purine rich foods may help. Organ meats such as kidney, brain and seafood's are rich in purine. Avoiding Alcohol especially Beer and liquor is necessary. Fructose from soft drinks increases the frequency of attacks. Diary products may decrease the attacks. Weight reduction decreases the attacks.           

Vitamin C and Dietary Calcium may reduce the frequency of attacks.