Gout

What is Gout?

Gout is caused by too much uric acid in the body. Uric acid is made from the breakdown of purines (parts of tissues). This uric acid normally dissolves in the blood, goes through the kidneys and finally leaves the body in our urine. A disruption in this normal body process is a condition known as hyperuricemia. When the body fails to control the increase in uric acid, results in crystals of uric acid accumulating in joints or tissues of bones, or in both. Hyperuricemia is not dangerous, but when these crystals become hard, it causes an extremely painful condition called gout which is a form of arthritis.

Gout causes inflammatory arthritis (joint inflammation), swelling, redness, heat, stiffness in the joints and pain. A low fever of 99°F to 100°F is common. Rheumatic pain that affects tissues, joints, bones, muscles and other structures is called arthritis. Gout is responsible for about 5% of this type of arthritis. Gout is both a progressive and a chronic disease. This is because chronic gout may result in the formation of kidney stones. The deposits of hard lumps of uric acid, in the tissues and particularly in the joints, destroys the joints, reduces function of the kidney and ultimately stones in the kidneys.

Gouty arthritis is the most common inflammatory arthritis in men over the age of 40. Gout can occur by itself, called primary gout, or along with other medical conditions, called secondary gout. Gouty arthritis is the most common inflammatory arthritis among men over the age of 40. Diagnosed after the detection of uric acid in the synovial fluid, the uric acid crystals can accumulate in the tissues around joints over many years. Chronic arthritis develops after repeated attacks of gouty arthritis. Gout can be treated even though it may be progressive.

Stages of Gout

In about 75% of people, gout begins by attacking the joints of the big toe. It eventually may involve the ankles, knees, fingers, and elbows. Attacks can last from several days to weeks. Months or years can go by between attacks with no symptoms. Attacks gradually occur more often, last longer and become more severe. Gout then progresses in four different stages:

  • Asymptomatic Hyperuricemia – a stage in which there are no symptoms, but there are increased levels of uric acid. Treatment is not required.
  • Acute Gouty Arthritis – this is the stage where crystals of uric acid begin to deposit in the joints causing swelling and pain. The affected area becomes warm and tender. Extreme pain attacks occur usually at night. Stressful events, alcohol or drugs, or even another illness may make the pain worse. Initial attacks get better in about 3 to 10 days, but over time attacks can be long lasting and more frequent.
  • Intercritical Gout or Interval Gout – Between stages of acute gout, there are periods of normal joint function known as interval or intercritical gout. During this period, there very little, if any, pain or discomfort.
  • Chronic Tophaceous Gout – this stage is acquired over a period as long as 10 years. Definitely a disabling stage, as by now, the affected joints or even the kidneys are completely damaged and beyond repair. However, patients given proper treatment in the first stages of gout can prevent this stage from happening.

Gout Causes

Though men and women can get gout, it affects men much more often. Gout affects men after puberty, but women are affected after menopause. Anyone who has undergone an organ transplant may be at the risk of developing gout at any age.

Heredity can be a cause for the occurrence of gout, but other factors are also responsible for gout. If both parents have gout, there is about a 20% chance the child will be affected as well.

Nutrition or eating habits also play a major role in gout. Unhealthy eating habits, such as eating too much junk food or alcohol—especially beer; high protein foods such as red meats, oily fish and yeast may increase the chances of gout. Very low-calorie diets can also be a factor.

Wearing shoes that don’t fit well may lead to gout.

Obesity and other nutrition factors such as starvation, dehydration or any kind of trauma are uncommon causes for gout.

Certain medicines can also cause gout. They lower the body’s ability to reduce uric acid levels in the blood. Aspirin, niacin also called nicotinic acid, cyclosporine, levodopa, are among some of the medicines that can cause gout. Certain medicines that treat tuberculosis—pyrazinamide and ethambutol—are also harmful. Diuretics used to treat heart diseases, hypertension and edema, can reduce the uric acid passed in the urine considerably, resulting in gout.

In addition to medicines, certain diseases can cause gout including lymphoma, leukemia and diseases related to hemoglobin disorders.

Gout Symptoms

Gout usually starts in the base of the big toe; acute gouty arthritis at the toe’s base is called podagra. Initial symptoms include swelling, redness, warmth, discoloration and tenderness in the affected area. The amount of the pain or tenderness cam be so bad that the mere touch of a bed sheet can be extremely painful. Gout also affects other joints such as knees, ankles, elbows, wrists, and fingers.

The first attack may go away within a few days or weeks with or without treatment. Over time, the attacks become more frequent and last longer. In addition to the local joint pain and swelling, you may also have a fever. The first attack may be in only one joint, but multiple joints may be involved as gout progresses.

The uric acid deposits, which cause the gout, may start forming the external parts of the body. The collection of urate crystals, called tophi, can be found on the elbows, ear lobes and on the back of the ankle (called Achilles ankle). The external crystals are not painful. Inside the body around the joints, these crystals collect in small liquid-filled sacs, called bursae, which lead to swelling and intense pain. Inflammation of the bursae is called bursitis. In chronic gout, these crystals can even be found in the vocal cords and spinal cord.

Kidney stones are is a major sign of the presence of gout. In rare cases, gout may cause complete kidney failure.

Insomnia, sleep loss, and loss of appetite can also be symptoms of gout.

Gout Diagnosis

Joint Aspiration

It can be difficult to diagnose gout, because the symptoms are sometimes vague and can be the same as joint infections. The most reliable test for gout is joint aspiration, called arthrocentisis. In this test, a sample of the synovial fluid of the affected area is taken with a syringe. This sample is then viewed under a microscope to check for the presence of urate crystals. If you have a medical history and symptoms of gout, you can be treated without undergoing joint aspiration.

Blood Tests

Blood tests may also be done to check cell counts, kidney function, and uric acid levels. Blood tests are not very reliable, because, during an actual gouty arthritis attack, there is an abnormal reduction in uric aid levels.

Xrays

An xray can help detect the presence of uric acid or damage to the bone due to repeated gout attacks.

Gout Treatment

The treatment of gout involves three major steps:

  • stopping the immediate pain due to an inflammation
  • take preventive measures for future gout attacks
  • prevent the formation of more urate crystals as well as kidney stones

Successful treatment can be achieved by following a gout diet and taking gout medicines. Dietary changes include increasing fluids and reducing alcohol and beer intake.

As soon as you know you’re having an attack, get off your feet and elevate the affected joint. Stay off your feet until the most severe symptoms have gone away or gotten much better. This can help prevent another attack from happening. If the sheets cause pain on your toe, try creating a “tent” over your toe to prevent the sheets or blankets from putting pressure on your toe.

Take ibuprophen, ketoprophen or naproxen for pain relief. Do not take aspirin because aspirin can make it harder for your kidneys to get rid of the excess uric acid. If your doctor has prescribed medicine for you to take during an attack, take it exactly as prescribed. If the medicine causes nausea, vomiting, diarrhea or abdominal cramps, stop taking it and call your doctor.

You should call your doctor if you have a sudden onset of joint pain especially with pain, redness and swelling over the joint.

Gout Diet

Alcohol is a major contributor to acute gouty arthritis. Alcohol not only reduces the level of uric acid excreted from the kidneys but also causes dehydration. Both of which increase the collection of uric acid crystals in the joints. It is very important to stop or severely reduce alcohol consumption.

Seafood and organ meats—such as liver, brain, kidney, heart—are purine-rich foods. These foods should be left out of your diet. Your body converts the purine in food into uric acid. Instead, eat dairy products which do not have harmful effects in people with gout.

If you have gout, your diet should include vegetables, fruits, fruit juices, honey, garlic. Eat a lot of green leafy vegetables like cabbage. Juices from carrots, French beans, beet root, oranges and cucumbers are very effective in treating gout. Oranges, bananas, apples, grapes and cherries are good to include in your diet.

Gout Home Remedies

There are some home remedies, which help treat gout. Boiled and drained cabbage leaves can be wrapped in perforated paper and then bandaged on the affected area 3 to 4 times a day to help relieve the pain. Similarly, drinking honey and apple vinegar in equal quantities, mixed in a glass of water, can help the healing process.

In addition to diet, gout can be treated at home with home-made massage oils. Boil a mixture of rose petals and vinegar until both ingredients mix well. Cool the mixture and apply to the inflamed area to reduce pain. Soaking your foot in lukewarm water mixed with apple vinegar can also help. You can make an ointment with vinegar, black pepper and water: boil the water and vinegar, add 1 or 2 teaspoons of black pepper. Remove from he heat and let cool. Apply to the affected area.

Ice packs can also help relieve pain. Support your body weight so that the affected area does not bear weight. Using a cane or crutch may help.

Aerobic exercises are recommended can help you lose weight which can help cut down gout attacks as well as reduce the amount of weight on painful feet.

Gout Medicine

Gout medicines include pain killers, anti-inflammatory medicines to manage inflammation, and medicines to control the uric acid level.

Pain killers or relievers: Analgesics like acetaminophen (Tylenol) are used to control the pain.

Nonsteroidal Anti-Inflammatory Drugs – better known as NSAIDS: This class of medication is used to manage the inflammation caused by the uric acid crystals, but NSAIDs do not reduce the uric acid levels. The first medicines are indomethacin and naproxen, taken every day by mouth. If you are allergic to aspirin you should avoid NSAIDs. Intestinal ulcers and gastrointestinal irritation are common side effects of NSAIDs.

Corticosteroids: If you can’t take NSAIDs you doctor may prescribe corticosteroids—another kind of anti-inflammatory. Prednisone is the most common corticosteroid prescribed. Also known as adrenocorticotropic hormone (ACTH), corticosteroids are administered by mouth or as an injection into the muscle. Recovery is usually within a week. High blood pressure, changes in mood and difficulty controlling blood glucose levels are some of the side effects with short-term use of corticosteroids.

Colchicines: When NSAIDs and corticosteroids don’t work, you may be prescribed colchicine. This medicine is used to cure inflammation and prevent further attacks. When treating inflammation, the medicine is often given – once every hour until the pain is under control. Some colchicines are given once or twice a day to prevent further attacks. Side effects include vomiting, nausea and diarrhea.

In addition to these medicines, a few others which help fight gout including:

Probenecid: This uricosuric agent is not used as a treatment, but to prevent future attacks. While taking Probenecid, drink lots of fluid—this medicine works by helping the body get rid of excess uric acid through the kidneys. In rare cases it can cause the formation of kidney stones. Therefore, to avoid kidney stones, a high fluid intake is a must.

Allopurinol: A very reliable medicine used to reduced the level of uric acid in the blood. This medicine actually prevents the purines in food from being converted into uric acid. If you have kidney problems, be careful while taking this medicine as it can have severe side effects such as rash and liver damage. An extremely rare hypersensitivity may occur and can be fatal.

Febuxostat: Another very reliable and recent medicine used to lower uric acid levels in the blood. It is usually given every hour or two, until the pain is controlled. I can also be given to people with kidney problems. A side effect of this medicine is diarrhea. While you are taking this medicine, your uric acid and liver functions should be tested regularly.

Though, there are a number of medicines available to treat gout, yet it must be remembered that not all medicines can be given at the time of an acute gouty attack. At the time of inflammation, an anti-inflammatory drug must be given first and when the pain subsides only then can colchicines be given, after consultation with the doctor. This precaution should be taken since colchicines if given during the attack, increases the pain instead of reducing it.

Gout Prevention

If you have been diagnosed with gout, you may not be able to prevent it from developing but there are certain things you can do to help reduce the frequency or severity of attacks.

  • Eat a healthy and balanced diet. Avoid foods that contain purines. Drink plenty of fluids every day (8-10 glasses of water) to help flush the uric acid out of your system. Eat fresh fruits and vegetables. Increase dairy products in your diet.
  • Get to and keep up healthy body weight. Include regular, daily exercise.
  • Reduce or eliminate the amount of alcohol you drink, especially beer. Alcohol increases the production of uric acid.
  • Take all medicines exactly as prescribed. Report any problems to your doctor. Get an evaluation of new medicines you take to keep uric acid levels low as well as increase the elimination of uric acid through urine. Do not take aspirin.

Treating gouty arthritis is life-long and your lifestyle can help prevent it or at least reduce the symptoms.

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