Gout: Causes, Symptoms, Treatment

Gout is a form of arthritis, usually characterised by sudden burning pain, redness, and swelling in a joint, most commonly in the big toe due to high levels of uric acid in the blood.
Elevated uric acid in blood leads to sharp needle-like uric acid crystals to deposit in the joints, causing inflammations and other symptoms.
Men are more likely to experience gout and they usually develop it earlier— the most common age range is 30 to 50. Women become increasingly susceptible to gout after menopause.
Gout can have various course of presentation. It may be acute, lasting a few days to a week; or chronic (tophaceous) gout which develops over a long period, such as 10 years. An asymptomatic prolong interval between attacks is also common.
Significantly, however, not every person with high uric acid level in their blood develops gout. So, do not be alarmed unless the symptoms are present.

Causes and Risk Factors

-Consuming too much meat and fish that are high in  chemicals called purines.
-Family members with the disease.
-Previous joint injury or history of arthritis of any kind.
-Recent surgery, severe illness or infection.
-Obesity or overweight.
-High blood pressure
-Diabetes or heart disease.
-Any sort of kidney diseases.
-Drinking too much alcohol.
-Dehydration.
-Starvation.
-Beverages sweetened with fructose. Most soft drinks and artificial fruit juices have high level of fructose.
-Vitamin overdose, especially vitamin B3 or niacin.
-Medicines, such as water pills (thiazide diuretics), aspirin, cyclosporine or levodopa may predispose an episode.
-Congenital, due to an enzyme defect needed for urea excretion.

Symptoms

*Redness and tenderness in joints; often at the base of the big toe giving sensation that it is on fire. The pain often wakes the person up in the middle of the night. In moderate cases, patients cannot wear shoes; even weight of a sheet on the joint may seem intolerable while trying to sleep.
Gout may also affect other joints such as ankles, heels, knees or wrists.

*Tophi, which look like lumps under the skin of fingers, hands, feet, elbows or achilles tendons along the backs of ankles are also features of long standing gouts. They are usually not painful, but may become swollen and tender during an acute attack.
*Kidney stones due to urate deposition in the kidneys.
Lingering discomfort may persist even after an acute episode.

Diagnosis

-The most reliable method to diagnose gout is to aspirate joint fluid from an inflamed joint and examine under a microscope to see needle shaped uric acid crystals.
-High level of uric acid in the blood or urine, but may not be present always.
-X-ray imaging also helps to rule out other causes of joint pain.

Treatment

-In an acute attack, NSAIDs (eg: indomethacin, Naproxen) or Colchine work best.
-In severe cases, intra-joint steroid injection is beneficial as it lowers inflammation.
-In chronic or recurrent cases, Allopurinol or Probenecid needs to be prescribed as they help to prevent formation and increase excretion of uric acid from the body.

Sometimes, in chronic gout, starting treatment can in turn precipitate a gouty attack by mobilising the crystals from the tophi to the joint spaces. So, a NSAID cover should be co-prescribed.

Prevention

As a general rule, avoid eating too much animal proteins.

Here are food items that are harmful for gout:
*Animal meat or organ meats such as liver, kidney, spleen, brain. *Dried beans and peas. *Some seafood and fish, and fish eggs. *Alcohol.  *Mushrooms. *Canned fruits in sugar syrup. *Too much nuts, legumes or lentils. *Sodas or fruit juices containing high sugar/fructose. *Honey. *Berries

Foods items which are safe:
*Whole grains, like wheat, brown rice, oats and barley. *Complex carbohydrates. *Plant oils, such as soybean, olive, canola or sunflower.  *All kinds of vegetables. *Fruits that are less sweet.

The following items/supplements have shown to reduce attacks:
*Vitamin C (500 to 1,000 mg daily). *Coffee and green tea. *Hot peppers. *Fruits like cherries, apples, pineapples and bananas.  *Ginger and turmeric as they have anti-inflammatory properties. *Apple cider vinegar.
Also, avoid crash diets and fasting during an acute episode.

Tips

List all the medications to your doctor, including the vitamins you take.

Manage your weight; get exercise.
Drink plenty of water (>2 L/day)
Try to get your protein from low-fat dairy products, such as skim milk or yogurt. Soy milk or tofu is also excellent source of protein for gout patients.
A person must seek medical treatment if he or she is experiencing gout, as the disease if untreated may lead to permanent joint deformity, kidney or heart problems and unsightly lumps under the skin. With proper lifestyle modifications and drugs, gout can be easily manageable these days. 

The writer is a doctor of internal medicine.

Gout: Causes, Symptoms, Treatment

Gout is a form of arthritis, usually characterised by sudden burning pain, redness, and swelling in a joint, most commonly in the big toe due to high levels of uric acid in the blood. Elevated uric acid in blood leads to sharp needle-like uric acid crystals to deposit in the joints, causing inflammations and other symptoms. Men are more likely to experience gout and they usually develop it earlier the most common age range is 30 to 50. Women become increasingly susceptible to gout after menopause. Gout can have various course of presentation. It may be acute, lasting a few days to a week; or chronic (tophaceous) gout which develops over a long period, such as 10 years. An asymptomatic prolong interval between attacks is also common. Significantly, however, not every person with high uric acid level in their blood develops gout. So, do not be alarmed unless the symptoms are present. Causes and Risk Factors -Consuming too much meat and fish that are high in chemicals called purines. -Family members with the disease. -Previous joint injury or history of arthritis of any kind. -Recent surgery, severe illness or infection. -Obesity or overweight. -High blood pressure -Diabetes or heart disease. -Any sort of kidney diseases. -Drinking too much alcohol. -Dehydration. -Starvation. -Beverages sweetened with fructose. Most soft drinks and artificial fruit juices have high level of fructose. -Vitamin overdose, especially vitamin B3 or niacin. -Medicines, such as water pills (thiazide diuretics), aspirin, cyclosporine or levodopa may predispose an episode. -Congenital, due to an enzyme defect needed for urea excretion. Symptoms *Redness and tenderness in joints; often at the base of the big toe giving sensation that it is on fire. The pain often wakes the person up in the middle of the night. In moderate cases, patients cannot wear shoes; even weight of a sheet on the joint may seem intolerable while trying to sleep. Gout may also affect other joints such as ankles, heels, knees or wrists. *Tophi, which look like lumps under the skin of fingers, hands, feet, elbows or achilles tendons along the backs of ankles are also features of long standing gouts. They are usually not painful, but may become swollen and tender during an acute attack. *Kidney stones due to urate deposition in the kidneys. Lingering discomfort may persist even after an acute episode. Diagnosis -The most reliable method to diagnose gout is to aspirate joint fluid from an inflamed joint and examine under a microscope to see needle shaped uric acid crystals. -High level of uric acid in the blood or urine, but may not be present always. -X-ray imaging also helps to rule out other causes of joint pain. Treatment -In an acute attack, NSAIDs (eg: indomethacin, Naproxen) or Colchine work best. -In severe cases, intra-joint steroid injection is beneficial as it lowers inflammation. -In chronic or recurrent cases, Allopurinol or Probenecid needs to be prescribed as they help to prevent formation and increase excretion of uric acid from the body. Sometimes, in chronic gout, starting treatment can in turn precipitate a gouty attack by mobilising the crystals from the tophi to the joint spaces. So, a NSAID cover should be co-prescribed. Prevention As a general rule, avoid eating too much animal proteins. Here are food items that are harmful for gout: *Animal meat or organ meats such as liver, kidney, spleen, brain. *Dried beans and peas. *Some seafood and fish, and fish eggs. *Alcohol. *Mushrooms. *Canned fruits in sugar syrup. *Too much nuts, legumes or lentils. *Sodas or fruit juices containing high sugar/fructose. *Honey. *Berries Foods items which are safe: *Whole grains, like wheat, brown rice, oats and barley. *Complex carbohydrates. *Plant oils, such as soybean, olive, canola or sunflower. *All kinds of vegetables. *Fruits that are less sweet. The following items/supplements have shown to reduce attacks: *Vitamin C (500 to 1,000 mg daily). *Coffee and green tea. *Hot peppers. *Fruits like cherries, apples, pineapples and bananas. *Ginger and turmeric as they have anti-inflammatory properties. *Apple cider vinegar. Also, avoid crash diets and fasting during an acute episode. Tips List all the medications to your doctor, including the vitamins you take. Manage your weight; get exercise. Drink plenty of water (2 L/day) Try to get your protein from low-fat dairy products, such as skim milk or yogurt. Soy milk or tofu is also excellent source of protein for gout patients. A person must seek medical treatment if he or she is experiencing gout, as the disease if untreated may lead to permanent joint deformity, kidney or heart problems and unsightly lumps under the skin. With proper lifestyle modifications and drugs, gout can be easily manageable these days. The writer is a doctor of internal medicine.