Gout is one of the oldest types of arthritis that affects mankind. It has been known since before the days of Christ. Gout is also one of the commonest types of arthritis. It causes inflammation of the joint, with swelling, warmth, redness and pain.
Nowadays, due to advances in medical research, gout can be well controlled. If the correct treatment program is followed, gout becomes an easily manageable illness.
What is Gout?
Gout is a disease in which there is a build-up of uric acid in the body. A relatively small amount comes directly from the food we eat. Uric acid forms in the blood of healthy people as a breakdown product of various chemical processes. Normally, the body rids itself of any excess through the kidneys into the urine, so levels tend to be higher in people with kidney disease.
If the body cannot get rid of enough uric acid, there is a build-up of uric acid, some will be deposited in joints. This may cause acute inflammation of the affected joints (acute gouty arthritis).
Attacks usually occur very quickly, often overnight, unlike most other forms of arthritis, which usually start more gradually. The affected joint rapidly becomes very painful, often to the point that even the weight of a bed sheet is unbearable. Untreated, each attack lasts approximately 1-2 weeks. After the first attack, which almost always involves only one joint, it is usually months or years before the next one occurs. But without the right management, attacks become more frequent, last longer and may involve other joints. Repeated attacks can lead to progressive joint damage, disability and crippling (chronic gout).
Attacks often occur for no obvious reason but can be triggered by:
Uric acid can also be deposited in other tissues. This usually occurs near the affected joints or around the elbow, toes, fingers and even the outer edge of the ear. These deposits look like little white pimples on the skin and are called tophi (Fig 2). Tophi usually take many years to be easily seen.
In some people, excess uric acid can be deposited in the kidney as stones, or less commonly in the bladder as gravel or multiple stones. This can cause problems with kidney functions and sometimes, severe pain.
• Acute gout is a very painful condition
Who gets Gout?
Uric acid in the blood stream travels in the clear part of the blood – the plasma- in the form of a salt called urate. The plasma urate is measurable and normally tends to be higher in men than women.
Almost all people with gout have too much urate in their blood, a condition called hyperuricaemia. It usually occurs when (1) the kidneys cannot get rid of enough uric acid; (2) the body overproduces uric acid. These two defects are usually inherited from a parent or grandparent. Gout runs in families. The old adage that simply eating and drinking too much causes gout has been proven wrong, though it is true if you over-indulge in alcohol – especially beer and wine – or high purine content food.
Being overweight or not drinking enough fluids can also aggravate gout.
About 90% of people with gout are men. The first attack generally occurs between 40 and 50 years of age, but can occur at any age. Women with gout usually develop it after menopause.
How is gout diagnosed?
A sudden attack in one joint (usually the big toe) suggests a diagnosis of gout, but some other forms of arthritis can also act like gout, especially pseudogout and septic arthritis. It is important for a doctor to make an accurate diagnosis. The plasma urate can be measured by a blood test. It is usually raised during an attack but it can also be normal sometimes. On the other hand, a raised blood uric acid level can also happen in normal subjects who do not have gout; therefore a raised blood uric acid level does not necessarily indicate gout.
How is gout treated?
a. For the acute attack
b. Long term
• Avoid excessive alcohol. More than one glass of wine or one can of beer a day can raise uric acid levels.
• Diets. Special diets used to be prescribed, but since the effective treatment has been found, most sufferers can eat or drink anything they like. However, certain foods can cause increased uric acid levels. It is sensible to avoid them or reduce the intake. These include liver, brains, kidneys, sweetbreads (pancreas), anchovies, leguminous vegetables, roe, yeast, broths, gravies and sardines. Avoid periods of sudden strict starvation because this can start an attack of gout. Increased consumption of low- fat dairy products can help to reduce uric acid levels.
Uric acid lowering drugs
The drugs given to relieve an acute attack have little effect on uric acid levels in the blood. They can do little to prevent further attacks, or stop uric acid being laid down in the joints. Should your attacks become more frequent, or if blood tests show you are accumulating too much uric acid, your doctor may decide to prescribe one of the drugs that reduce the quantity of uric acid in the blood. These have to be taken everyday, whether you have an attack or not, as a preventive measure.
There are now several drugs available that will lower the uric acid level, but it must be appreciated that you may have to persist with the daily treatment for the rest of your life. Should you stop, uric acid will begin to accumulate again.
These tablets are prescribed to be taken regularly. Taken consistently over a period, the treatment ensures that you maintain a normal blood level of uric acid.
The most commonly prescribed tablet is Allopurinol. It reduces the amount of uric acid made by the body. It is well tolerated even when taken for years; the only side-effect that occurs frequently is a rash, which disappears when the tablets are stopped. Occasionally, people may be allergic and have more severe skin rashes.
Sometimes acute attacks of gout may become more common when Allopurinol is started, so it may be necessary to take Colchicine or an NSAID as well. Whichever drug proves right for you, drinking plenty of fluid will help to get rid of uric acid through the kidneys.
Conditions that are associated with Gout
Gout is commonly associated with high blood pressure, diabetes mellitus, coronary artery disease and high cholesterol. These conditions should be checked regularly and treated.
Gout is a treatable disease. Proper diagnosis and management, including weight and diet control, should mean gout can be totally controlled.
|** this info was taken from the Arthritis Foundation of Malaysia website**|