Gout - Symptoms and Treatment

Gout is a disease which involves small joints and presents as pain and swelling.

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:   

Treating gout can cause the disease to become less progressive. Goals of Treatment are to stop the acute attack and prevent further attacks. Over time, without treatment, gout can begin to affect more joints throughout the body and cause problems like gout tophi and permanent bone damage.

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 of Gout attacks :      

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,liver, brain, heart etc and seafood such as anchovies, mussels, crab, shrimp, sardines, herring, trout, mackerel, and more are rich in purine. Poultry and beef contain fewer purines, so you can safely eat them in moderation. Since Fish is a heart healthy food, instead of avoiding fish you can consume smaller servings of higher-purine fish, around the size of your palm, with a big serving of vegetables seasoned with lime juice. Lemon juice is said to help neutralize uric acid. And also use fish such as Cod, Sole etc that are lower in purines.

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.