Gout

Joints are important part of human body. Joints help us move and carry out various functions. Ever wondered what would happen if the joints become stiff and do not move? What would happen, if even a slightest movement cause extreme pain? Yes, we would come to a standstill and get stranded. It is important to take care of our joints and keep them healthy, to keep one going.

Gout and its causes

Gout is a common and painful form of arthritis (disease of the joints), caused by deposition of uric acid crystals in the joints.

Uric acid is the normal waste product formed when the body breaks down substances called purines, found in all the body’s cells. This uric acid is usually in a dissolved state in the body and is excreted out of the body through urine. However, if the level of uric acid in the body is too high to be eliminated completely or if the body is unable to wash out all the uric acid produced, the uric acid forms needle-like crystals which deposit in the joints.

These crystals cause pain when the affected joint is moved. In addition, these crystals attract white blood cells of the body which mounts an inflammatory reaction in the affected joint. This inflammatory reaction causes the joint to become red, warm, swollen, stiff, and tender.

Managing a gout attack

In addition to taking the medications, you may adopt some measures to manage the pain and swelling.

  • During a gout attack, give rest to the affected joint and keep it elevated; pain may be eased by applying cold packs.
  • Keep yourself hydrated and drink plenty of fluids to help your kidneys wash off the extra uric acid in the body.
  • You should avoid eating purine rich foods especially meats, and consuming alcohol.
  • The protein intake should be moderate and preferably from healthy sources like low-fat or fat-free dairy, tofu, eggs, and nut butters.

Diagnosis

If you have these symptoms, consult your doctor immediately. The doctor may take a detailed medical history and do a physical examination. He would ask about your symptoms, its duration and intensity.

He would examine and assess the status of the affected joint. Thereafter, some tests may be prescribed. The fluid in the joints may be aspirated through a needle, called joint fluid test, and examined under a microscope to conform the presence of uric acid crystals.

Blood tests may also be done to know the uric acid levels in the blood.

Symptoms

The symptoms of gout attack are often acute, sudden and come without a warning, and starts usually at night. Mostly, the lower joint of the big toe is affected by gout, however other joints like feet, ankles, knees, hands and wrists.

The pain in the affected joint is most severe for the first 12 to 24 hrs after which it decreases, but the discomfort stays for days and weeks.

Due to the inflammation the joint appears red, feels warm and is swollen. The joint is so tender that even the weight of the bed sheet may cause pain.

These attacks are recurrent; may come and go initially, but their frequency and intensity gradually increases.

If left untreated, the uric acid can get deposited soft tissues and form lumps under the skin, called as tophi. The uric acid can also get deposited in the kidneys causing damage and failure.

You may have an increased risk of developing gout if you have increased levels of uric acid in the body.

Uric acid levels in the body may increase if you eat food items rich in purines like shellfish, salmon, sardines, organ meats, asparagus, mushrooms, and herring. If you have certain medical conditions like cancer, obesity, high blood pressure, high cholesterol levels, and diabetes, then your chances of developing gout increases.

As uric acids are washed out through kidneys, any disease of the kidneys also increases the likelihood of gout.

Medications like water pills, aspirin, and drugs used to suppress immune system increase the likelihood of developing gout.

Gout affects men more than women, but after menopause women too have an equal risk. If you have a family member with gout, then your risk of getting the disease increases. In addition, alcohol consumption tends to increase the risk of developing gout.

The sooner you perform gout treatment, better it is for your joints. Your doctor may prescribe medications for treating your pain and swelling, and preventing future attacks.

Non-steroidal anti inflammatory drugs (NSAIDs) like ibuprofen, indomethacin, and naproxen can be taken to relieve pain and swelling in the joints.

Another drug, colchicines, is effective in relieving the pain if taken early during the attack. For people who cannot take NSAIDs and colchicines, due to other medical conditions or side effects corticosterioids can be used. Corticosteroids can be taken as a pill or injected directly into the joint.

Once the acute attack subsides, your doctor may prescribe medications to prevent future attacks, these medications include drugs that block the production of uric acid, like allopurinol, and drugs that promote removal of uric acid from the body, like probenecid.

  • A gout attack in the future can be prevented by taking medications regularly and adopting certain lifestyle changes.
  • Obesity tends to increase the risk of gout so the first thing to do is to shed the extra pounds. But this should be done gradually, as crash diets many cause excess weight loss and increase the uric acid levels.
  • Keeping yourself hydrated at all times, helps in keeping the uric acid in dissolved form and helps the kidneys wash it off. Aim to drink at least 2 to 4 litres of fluids, half of which should be water.
  • Dietary modifications are necessary to prevent gout attacks in future. The gout foods which should be consumed are:

Avoid meat, fish and poultry; include more of fruits, vegetables, and whole grains in your diet. Dairy products should be fat-free or low-fat. Limit your alcohol intake. You may talk to your doctor about the amount you can take.