Gout is a very painful, intermittent type of arthritis brought about by a malfunction of the body's metabolism which results in elevated blood levels of uric acid causing the formation of uric acid crystals in the joints. It can occur in any joint but is most common in the big toe and while episodes are almost debilitating when they occur, there can often be long periods between attacks.
Gout strikes about 4 times as many men as women with symptoms appearing in men around the late 30s or early 40s and in women usually after menopause.
Causes and Incidence of Gout:
There are two types of gout, primary and secondary, the latter occurs in older people and is usually associated with diseases such as; diabetes, obesity, hypertension, renal failure and psoriasis. Usually only one joint is affected when gout is first diagnosed but in about 10% to 20% of cases patients can present with polyarticular gout where several joints are involved. Polyarticular gout is usually only seen in elderly patients.
There is a suggestion that a genetic factor causes the over production and retention of uric acid in primary gout.
Risk Factors:
Obesity, high alcohol intake, rich foods, red meat, organ meats, sardines, anchovies, peas and lentils, fish and shellfish have all been implicated in gout attacks. Some medications can also exacerbate the condition. Other risk factors include high blood pressure and poor kidney function.
Signs and Symptoms of Gout:
There are four stages of gout;
1. Asymptomatic gout where serum urate levels are elevated but there are no symptoms.
2. Acute gout when a sudden and very painful attack occurs usually only involving one joint. The joint will present as inflamed, red and will feel hot and sometimes a low grade fever is present. Attacks may only last a few hours but can last weeks.
3. Intercritical gout is the period between attacks which can vary between a few months and 10 years. The longer the period between attacks, the more likely it is that the attacks will be more severe and will involve more joints.
4. Chronic gout is usually polyarthritic with constant pain, fever, loss of appetite, swelling and the involvement of tendons, synovial membranes and soft tissue. Joint surfaces are commonly damaged and the joints are deformed. Tophi which are painless deposits of uric acid crystals in areas such as the ear lobes, elbows or the Achilles tendons are present in a significant number of cases.
Diagnosis of Gout:
Serum uric acid is an indicator but of itself this may be deceptive, white blood cell levels may be elevated and there are indications that thyroid hormone levels may be abnormal but the main indicator is the presence of monohydrate crystals in the synovial fluid of an inflamed joint. X-rays will show displacement and deformities of the joints as the disease progresses.
Treatment of Gout:
A multi-faceted treatment regime aimed at reducing pain and uric acid levels, preventing recurrence and complications is advocated. Dietary changes to reduce weight, reduction of alcohol intake, rich foods and fructose containing drinks are recommended as a start. Rest, immobilization of the joint and heat or cold packs can be useful. Pain relief can be achieved with analgesics, colchicine, NSAIDS and corticosteroids although care needs to be taken because of the possibility of serious side effects with long term administration of these medicaments. Recently the application of acupuncture pain patches has also been found to produce a drug free and instant reduction in pain levels. As with so many health problems, it is advisable to increase the amount of water the patient drinks.
There are also many natural products available for reducing gout symptoms, how effective they are is difficult to predict as there is very little in the way of serious published trial material available.
In severe cases joint replacement may become the only option to reduce pain and recover some mobility.
Complications:
Treatment can be complicated by the presence of infections, kidney stones, peptic ulcers, gastritis, hypertension or other medical conditions.
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