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Medical Term:
GOUT

Common Name:

 None Specified
Description: Gout is a disorder characterized by sudden, recurring attacks of very painful joints, caused by deposits of uric acid crystals, which accumulate in the joints because of an abnormally high level of uric acid in the blood (hyperuricemia). Crystals in the joints, cause pain, redness, warmth and swelling and most commonly affect the big toe. It may involve any large or small joint. 

It is 20 times more common in males.

Joint inflammation can become chronic and deforming after repeated attacks. Almost 20% of people who have gout develop kidney stones.

 

Causes:

Gout is caused by an abnormally  high level of uric acid in the blood due either  to increased production of uric acid or decreased elimination of uric acid by the kidneys. Normally, some uric acid, a by-product of cell breakdown, is present in the blood because the body is continually breaking down cells and forming new ones and also some foods contain precursors of uric acid. The uric acid level becomes abnormally high when the kidneys cannot eliminate enough in the urine or if the body produces an abnormally large amounts of  uric acid because of a hereditary enzyme abnormality or a disease such as blood cancer , in which cells multiply and are rapidly destroyed. Also, some types of kidney disease and certain drugs impair the kidneys ability to excrete uric acid.

Attacks of gout occur without warning. They may be triggered by a minor injury, surgery, consumption of large quantities of alcohol or protein-rich foods, fatigue, emotional stress, or illness. 

Prevention: Avoidance of risk factors where possible.

Avoid eating large amounts of anchovies, sardines, sweetbreads, kidney or liver.

 

Signs & Symptoms

Sudden onset of severe pain in the inflamed joint, usually at the base of the big toe or larger joints, such as the instep, ankle, knee, wrist and elbow.

Involved joints are red, hot, swollen, and very tender. Skin over the joint is red and shiny.
Sometimes may have associated symptoms of  fever, chills and a general sick feeling and a rapid heart beat.
In severe chronic gout - may develop joint deformities and restricted joint movements because of deposits of urate crystals in joints and tendons.
Hard lumps of urate crystals (tophi) are sometimes deposited under the skin around the joints. Tophi may erupt and discharge chalky masses of crystals.
Risk Factors

Use of drugs (water pills) such as hydrochlorothiazide, some antibiotics and ASA (aspirin).

Some blood diseases, such as polycythemia and leukemia.
Family history of gout.
Men over 60.
Obesity.
Many disorders including thyroid problem, kidney disease, anemia, hyperlipidemia, high blood pressure, sarcoidosis, psoriasis, diabetes, and vascular disease
Trauma, surgery, radiation treatment.
Polynesian extraction.
Radiation.
Diagnosis & Treatment
Gout is usually diagnosed on the basis of its distinctive symptoms and an examination of the joint. A high uric acid level in the blood supports the diagnosis; however this level is often normal during the acute  attack. The diagnosis is confirmed when urate crystals are identified in a sample of the fluid aspirated from the joint (removed by suction with the needle).

Goals of treatment are to control the symptoms and discover the underlying cause.

General Measures:
Use cold compresses on painful joints.
Keep the weight of bedclothes off any painful joint by making a frame that raises sheets off the floor.
Medications:
Non-steroidal anti-inflammatory drugs to control inflammation in the painful joints.
Prescription medications such as indomethacin or colchicine  may used to control the pain of the acute attack.
For some patients, lifelong medication, such as allopurinol to decrease uric-acid production or probenecid to increase the kidney's excretion of uric acid. These medications have significant side effects and adverse reactions. Obtain as much information as possible regarding their use.
Activity:

Acute attacks will end sooner with complete rest.

Diet:
Don't eat liver, sweetbreads, kidney, anchovies or sardines.
Drink 10 to 12 glasses of water daily. Large amounts of fluid keep the urine diluted (helps prevent kidney stones).
Don't drink alcoholic beverages, especially beer or red wine (they can worsen or trigger an attack).
If you are overweight, being a medically approved weight loss diet. Do not go on a crash diet, a quick weight loss may bring on a gout attack.
Possible Complications :
If untreated, may cause:
Crippled, deformed joints.
Kidney stones.
Inflammation of bones, ligaments and tendons.
Increased susceptibility to infections.
Nerve and spinal cord impingement.
Prognosis
With early treatment total control. In case of recurrent attacks , successful uric acid adjustment (requiring lifelong use of medication to control uric acid levels) is usually effective. However, during the first 6-24 months of treatment to control uric acid levels, acute gout may occur.
Other

 'Nothing Specified'.