Gout Arthritis
August 22, 2008 · Print This Article
Diagnosis and treatment
Since time immemorial, gout has caused much human suffering and has been researched extensively by physicians. Once known as the disease of kings and also the king of diseases, gout was seen as one of the leading causes of painful, disabling arthritis. With scientific advances in medicinal research, gout has been all but conquered. People who continue to suffer with gout often are found to be ignorant about new and effective treatments.
Excess uric acid in the body is recognized as the cause of gout. The excess can be caused by:
• Increased production of uric acid by the body.
• Insufficient discharge of uric acid by the kidneys.
• Increased intake of foods containing purines which are metabolized to form uric acid.
Certain seafood, meats, beans, and dried peas are very high in purines. Alcohol can also increase uric acid levels and lead to attacks of gout.
Increased levels of uric acid in the blood may result in deposits around the joints. Uric acid also can collect under the skin as tophi or in the urinary tract as kidney stones.
The sure and definitive diagnosis of gout depends on finding uric acid crystals in joint fluid during an acute gout attack. Uric acid levels in blood alone can mislead, as they can be transiently normal or low. Uric acid levels often are elevated in people who do not have gout.
Gout usually strikes a single joint rather suddenly and violently. The episode begins with redness, heat, swelling, and pain – all the classic signs of inflammation. Sometimes, gout can develop more slowly, involving multiple joints, resembling rheumatoid arthritis. The big toe is normally affected first with distinct pain, called podagra. Since 1800s, colchicine has been the standard treatment for acute gout. Common side effects of colchicine include nausea, vomiting, and diarrhoea.
When administered intravenously the side effects are less common. Because side effects of colchicine are sometimes problematic, for the treatment of acute attacks of gout NSAIDS are commonly used. Indomethacin is the most commonly prescribed NSAID for gout, but it must be watched for toxic side effects. Aspirin and aspirin-containing products are not recommended during acute gout attacks.
For patients who have had multiple gout attacks or developed tophi or kidney stones, stabilising uric acid levels should be considered. Probenecid helps the kidneys eliminate uric acid, and allopurinol blocks production of uric acid by the body. The medicine of choice is found out by the amount of uric acid in the urine.
• Gout affects about 840 out of 100,000 people.
• Gout occurs commonly and at a younger age in men.
• Gout is associated with diabetes, hypertension, hyperlipidemia, and obesity.
In almost all cases, gout should be well-controlled, with proper treatment. Gout is seen as one of modern medicine’s success stories.
