Gout

An Overview

Gout is a common and complex form of arthritis that can affect anyone. It’s characterized by sudden, severe attacks of pain, swelling, redness and tenderness in the joints, often the joint at the base of the big toe. t is the most common form of inflammatory arthritis in men and although it is more likely to affect men, women become more susceptible to it after the menopause.

People may experience gout with deposits of uric acid crystals in their finger joints. To ease the pain during a gout attack, rest the joint that hurts. An attack of gout can occur suddenly, often waking you up in the middle of the night with the sensation that your big toe is on fire. The affected joint is hot, swollen and so tender that even the weight of the sheet on it may seem intolerable.

Types of Gouts

• Asymptomatic hyperuricemia
• Acute gout
• Interval or intercritical gout
• Chronic tophaceous gout
• Pseudogout

Symptoms for Gout

The signs and symptoms of gout almost always occur suddenly, and often at night. Some people have too much uric acid in their blood, but no symptoms. This is called asymptomatic gout.

For acute gout, symptoms come on quickly from the buildup of uric acid crystals in your joint and last for 3 to 10 days.

You’ll have intense pain and swelling, and your joint may feel warm. Between gout attacks you won’t have any symptoms.

• Intense joint pain.Gout usually affects the large joint of your big toe, but it can occur in any joint. Other commonly affected joints include the ankles, knees, elbows, wrists and fingers. The pain is likely to be most severe within the first four to 12 hours after it begins.
• Lingering discomfort.After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints.
• Symptoms interrupt sleep. It is not uncommon to hear a gout sufferer recount how a gout flare-up struck in the middle of the night, waking the person from a sound sleep. The affected joint, often a big toe, causes so much pain that the person cannot tolerate even a bed sheet resting on it.
• Inflammation and redness.The affected joint or joints become swollen, tender, warm and red.
• The small joint at the base of the big toe is the most common site for an attack. Other joints that can be affected include the ankles, knees, wrists, fingers, and elbows. In some people, the acute pain is so intense that even a bed sheet touching the toe causes severe pain.
• Rapid onset. Acute gout can develop suddenly and without warning, taking only a few hours to become severely painful.⁷(Though not usually the case, it is possible for gout symptoms to appear more gradually)
• Limited range of motion.As gout progresses, you may not be able to move your joints normally.

Causes of Gout

However, only a small portion of those with hyperuricemia will actually develop gout. If your parents have gout, then you have a 20% chance of developing it.

• Gout occurs when urate crystals accumulate in your joint, causing the inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood.
• Your body produces uric acid when it breaks down purines — substances that are found naturally in your body.
• Purines are also found in certain foods, such as steak, organ meats and seafood. Other foods also promote higher levels of uric acid, such as alcoholic beverages, especially beer, and drinks sweetened with fruit sugar (fructose).
• re a middle-aged man or postmenopausal woman
• have parents, siblings, or other family members with gout
• drink alcohol
• take medications such as diuretics and cyclosporine
• have a condition like high blood pressure, kidney disease, thyroid disease, diabetes or sleep apnea.

Diagnosis

Your doctor can diagnose gout based on a review of your medical history, a physical exam, and your symptoms. The most reliable test for gout is detecting uric acid crystals in the joint fluid obtained by joint aspiration. This common office procedure is performed with topical local anesthesia. Your doctor will likely base your diagnosis on:

• Your description of your joint pain
• How often you’ve experienced intense pain in your joint
• How red or swollen the area is

Your doctor may also order a test to check for a buildup of uric acid in your joint. A sample of fluid taken from your joint can show whether it contains uric acid. The doctor may also want to take an X-ray of your joint.

Treatment

Commonly used medications include nonsteroidal anti-inflammatory drugs NSAIDs, colchicine or corticosteroids. These reduce inflammation and pain in the areas affected by gout and are usually taken orally. The treatment plan your doctor recommends will depend on the stage and severity of your gout.

Medications to treat gout work in one of two ways: They relieve pain and bring down inflammation, or they prevent future gout attacks by lowering uric acid levels.

Drugs to relieve gout pain include:

• Non steroidal anti-inflammatory drugs (NSAIDs), such as aspirin (Buffering), ibuprofen (Advil, Motrin) and naproxen (Aleve)
• Cochineal (Colcrys, Mitigate)
• Corticosteroids

Drugs that prevent gout attacks include:

• Xanthine oxidase inhibitors, such as allopurinol (Lopurin, Zyloprim) and febuxostat (Uloric)
• Probenecid (Probalan)

Prevention

During symptom-free periods, these dietary guidelines may help protect against future gout attacks:

• Drink plenty of fluids. Stay well-hydrated, including plenty of water. Limit how many sweetened beverages you drink, especially those sweetened with high-fructose corn syrup.
• Limit or avoid alcohol. Talk with your doctor about whether any amount or type of alcohol is safe for you. Recent evidence suggests that beer may be particularly likely to increase the risk of gout symptoms, especially in men.
• Get your protein from low-fat dairy products. Low-fat dairy products may actually have a protective effect against gout, so these are your best-bet protein sources.
• Limit your intake of meat, fish and poultry. A small amount may be tolerable, but pay close attention to what types and how much seem to cause problems for you.