What is gout?
Gout is a painful condition characterised by deposition of needle-like crystals of body waste, uric acid, in the joints and/or soft tissues. Affected persons experience intermittent swelling, heat, redness, pain and stiffness in their joints.
Gout initially develops in the joints of the big toe (a condition known as podagra), but other joints and surrounding areas like the ankles, heels, wrists, elbows, fingers and knees may soon get affected. Severe cases can lead to recurrent gout, lumps under the skin that surrounds the joints and covers the rim of ear (Tophi), or collection of uric acid crystals in kidneys leading to kidney stones.
What are the causes of the disorder?
Gout occurs due to the build-up of uric acid in the body. Uric acid is a waste product that is made daily in the body and dissolves in the blood to be passed through the kidneys and excreted out of the body. However, uric acid may sometimes form needle-like crystals, which when deposited in the joints cause pain and inflammation. This may occur when one’s body produces uric acid in excess (upon consumption of foods rich in purines) or the kidneys are unable to excrete all uric acid from the blood.
What one needs to know about symptoms or signs?
Symptoms of gout develop suddenly, often at night, are extremely painful and last for three to ten days.
You will experience the following symptoms:
- Inflammation in and around the joint
- Red, shiny skin over the affected joint
- Intense pain in the joints; most severe in the first 12-24 hours
- Itchiness and flaking of skin as inflammation subsides
Which specialist should be consulted in case of any of the signs and symptoms?
People experiencing symptoms common to gout must visit a rheumatologist who specialises in diagnosis and treatment of arthritis and other inflammatory conditions of the joints.
What are the screening tests and investigations done to confirm or rule out the disorder?
The symptoms of gout can be subtle and easily mixed with other conditions. Though hyperuricemia occurs during the course of the disease, it may not be present at the time of an acute attack. Gout is confirmed or other conditions are ruled out through the following:
- Blood tests – Serum uric acid levels are measured, though the test is not definitive. Healthy people who do not show obvious symptoms of gout may have high levels of uric acid in their blood, while those who experience an acute attack may show normal levels.
- Joint fluid test – A sample of synovial fluid is taken from the affected joint using a needle and syringe to check for crystals of sodium urate. This test helps to rule out other causes, like inflammation due to other crystals or an infection in the joint (septic arthritis).
- X-ray – Though not helpful in detecting inflammation due to gout, an x-ray serves to rule out other joint-related conditions such as chondrocalcinosis (deposition of calcium crystals).
What treatment modalities are available for management of the disorder?
Treatment for gout is directed towards the following:
- Relieving symptoms of a gout attack
- Preventing occurrence of future attacks
Treatment options include:
- Medication – There are different gout medications to treat acute attacks and prevent future attacks by reducing your risk of complications.
Medication to treat gout include:
- Non-steroidal anti-inflammatory drugs (NSAIDs) – Painkillers are used as an initial treatment of pain and inflammation.
- Colchicine – Pain-relieving medicine is generally used if NSAIDs do not suit a patient. It should be taken in low doses due to the side effects associated with it.
- Corticosteroids – Steroid are used to treat severe cases. Suitable only for short-term use due to side effects caused by them and exacerbation of diabetes and glaucoma conditions.
Medication to prevent gout-related complications operate in two ways:
- Blockage of uric acid production – Reduce risk of gout by lowering uric acid levels.
- Improvement of uric acid removal – Improve kidney’s ability to remove uric acid from the body (levels of uric acid in urine, however, increase).
- Self-care techniques – These include taking rest by keeping the affected limed in a raised position, and applying an ice pack on the affected joint (for a maximum of 20 minutes) with a towel separating the skin and ice for immediate relief.
- Lifestyle changes – Drinking plenty of water daily, avoiding alcohol, and limiting the amount of protein in one’s diet, and managing weight to reduce high uric acid levels in the body can be useful.
What are the known complications in management of the disorder?
The medications for gout can cause generic to severe side effects, especially if a person suffers from other medical conditions like high blood pressure or high blood triglyceride levels. Levels of uric acid also rise in overweight persons.
What are the dietary and physical activity requirements during the course of the treatment?
- Regular exercise to maintain a healthy body weight is essential. Keeping carbohydrate intake at sufficient levels is important, as the body cannot burn its own fat otherwise. This would release ketones into the bloodstream that can further increase the level of uric acid in the blood.
- Patients should drink plenty of water during the day and avoid consumption of alcohol. Non-alcoholic beverages can help remove uric acid from the body.
- Foods that are high in purines must be avoided.
Is there any risk to other family members of having the disorder?
Other members of a patient’s family are more likely to develop the disease as well. The chances of developing gout are higher in men and overweight persons.
How can the disorder be prevented from happening or recurring?
Medication can help lower uric acid levels in the body and improve the kidney’s ability to remove uric acid more efficiently. People can also reduce their risk to developing gout or prevent it from recurring by making changes in their diet. Regular exercise to keep body weight in check is beneficial in protecting oneself from future attacks.
“Gout,” Mayoclinic.com, Mayo Clinic Staff, http://www.mayoclinic.com/health/gout/DS00090
“Gout,” MedlinePlus, U.S. National Library of Medicine, National Institutes of Health, http://www.nlm.nih.gov/medlineplus/gout.html#cat1
“Questions and Answers about Gout,” National Institute of Arthritis and Musculoskeletal and Skin Diseases, http://www.niams.nih.gov/Health_Info/Gout/#diagnose
“Gout,” NHS.uk, http://www.nhs.uk/Conditions/Gout/Pages/Introduction.aspx