GOUT

Gout is a metabolic disorder that results from elevated level of uric acid in the blood. The uric acid may deposit in the joints that can present with sudden pain, swelling and redness. Uric acid may deposit in the tissues forming gout tophi, or deposit in the urinary tract causing painful renal stone. High uric acid may also affect the kidney function leading to nephropathy.

 

Causes

Painful gout attacks are caused by crystallization of the uric acid in the joint. Since uric acid is sensitive to temperature it forms crystals at cooler temperature, hence, gout attacks are more frequent in the cooler body joints. For this reason, the joint at base of the big toe are the most prone to gout attacks being the farthest away from the core body temperature.

Uric acid is found naturally in our body as a result of purine metabolism. Normally, the kidneys excrete the excess uric acid to maintain its level within normal. In some cases, the kidneys can't eliminate excess uric acid from the blood leading to increase in its level. In other cases related to enzymatic defect, the body can't digest purine leading to excess uric acid production from under digestion of the natural purine substance in food or the body. Eventually this leads to increase in uric acid as well.

Some medications are directly related to increase in uric acid level due to their effects on the renal excretion of uric acid. These are diuretic medications (water pills), aspirin, and some vitamins (nicacin). 
Other factors that are linked to gout include: high blood pressure, diabetes, obesity, surgery, chemotherapy and stress. Gout can affect men and women of any age, however, it is more frequent in men aged 40 to 60 years.  

Since uric acid is a byproduct of purine metabolism, consuming of high purine foods and beverages can trigger an attack of gout. Avoiding foods that are high in purine is recommended to reduce the chances of gout attacks. Shellfish, kidney, liver, red wine, beer and red meat are high in purines.

 

Symptoms

Sudden pain occurs at night with signs of inflammation (redness, swelling and warmth) over the joint.

 

Diagnosis

Your doctor will ask about your personal and family medical history and examination the affected joint. Laboratory tests and x-rays are ordered along with a joint fluid sample can be withdrawn for analyzing the uric acid crystals.

 

Treatment

Initial treatment of an attack of gout typically includes the following:

  • Medications. Prescription medications or steroid injection are used to treat the pain, swelling and inflammation.

  • Dietary restrictions. Foods and beverages that are high in purines should be avoided since purines are converted in the body to uric acid.

  • Fluids. Drink plenty of water and avoid alcoholic beverages which cause dehydration.

  • Immobilize and elevate the foot. Avoid walking to rest your foot. Keep your foot elevate to help reduce swelling.

  • Your doctor may consider prescribing daily uric acid lowering medicine in case of no resolution or recurrence of gout attack occurs.

The repeated gout attack may causes permanent damage to the joint and the kidney, therefor, the underlying cause must be addressed. 

 

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