Gout

Gout is a very common, painful form of arthritis which causes swelling, redness and stiffness of the joints. Gout is caused by increased levels of uric acid in the tissues and blood from abnormal metabolism. Eating certain foods rich in purines such as liver and dried beans can elevate the body’s level of uric acid. These increased levels of uric acid can also cause kidney stones. Gout usually affects the big toe and can later attack ankles, heels, knees, wrists, fingers, and elbows. If untreated, gout can result in permanent joint and kidney damage.

Pseudogout is a condition having similar symptoms, but is different from gout because it is caused from calcium phosphate rather than uric acid.

Causes

The exact cause for the development of gout is unknown. Gout occurs when there is increased production and decreased metabolism of uric acid, resulting in formation of uric acid crystals around the joints and in organs such as the kidneys.

Gout is more common in people having a family history of gout, those who drink alcohol, and taking certain medications which can raise the level of uric acid in blood. The probability of developing gout is higher in men and also in women after menopause.

People suffering from conditions such as diabetes, kidney disease, obesity, sickle cell anemia, leukemia and other blood cancers are more prone to develop gout. This is because the medication used for treating such conditions can interfere with removal of uric acid from the body.

Symptoms

Symptoms initially seen with gout include throbbing pain, warm, red, swollen joints, commonly in the big toe but can also involve other joints such as the knees, ankles, and small joints of the hands.

Initially such symptoms may affect one or two joints, lasting for 1-2 weeks, but as the disease progresses, multiple joints can be affected for a longer duration.

For patients with gout, the development of kidney stones and formation of uric acid crystals outside joints occurs more frequently. Such crystals, known as tophi, are painless but useful in diagnosis and may be found in earlobes, elbows and Achilles tendon.

Diagnosis

To make a diagnosis of gout your doctor will look at your symptoms and medical history.

Different tests are employed for assessing the level of uric acid in blood and also in urine. Along with this, synovial fluid analysis, which shows uric acid crystals, as well as synovial biopsy may be performed.

Synovial fluid analysis: A sample of your joint (synovial) fluid is taken from the affected joint and examined under the microscope to look for uric acid crystals.

Synovial biopsy: A synovial biopsy involves removal of a piece of the synovial membrane tissue lining a joint for examination under a microscope.

X-rays of the painful joint are recommended to assess any underlying joint damage due to gout. It is to be noted that high levels of uric acid does not always indicate gout.

Treatment

The conservative treatment of gout includes:

  • Nonsteroidal anti-inflammatory drugs to reduce pain
  • Ice packs can be applied to decrease pain and swelling
  • Elevation of the affected joint above heart level to reduce swelling
  • Corticosteroid injections may be injected into the swollen joint to relieve pain
  • Certain medications are prescribed to decrease the level of uric acid in the blood

In cases where severe damage of the joint has taken place due to lack of efficient treatment, surgery may be recommended.

Prevention

For preventing a gout attack, patients should eat a healthy diet, avoid alcohol, and if obese should try to lose weight. Try to limit eating purine-rich foods especially anchovies, oils, organ meat, legumes, mushrooms, spinach and cauliflower. Fatty foods should be avoided and increased carbohydrate diet may be recommended.