Gout – Hyperuricemia
What is Gout?
(Uric Acid Arthritis)
Gout is one of the most painful forms of arthritis. It occurs when too much of a substance called uric acid builds up in the body.
What Causes Gout?
Gout is caused by the buildup of too much uric acid in the body. Uric acid comes from the breakdown of substances called purines. Purines are found in all of your body's tissues.
Normally, uric acid dissolves in the blood. It passes through the kidneys and out of the body in urine. But uric acid can build up in the blood when:
- A person eats too many foods high in purines.
- Kidneys do not get rid of enough uric acid.
- The body increases the amount of uric acid it makes.
The excess uric acid in the blood may crystalize and lead to deposits around the joints over time.
The buildup of uric acid can lead to:
- Joints to become inflamed, with swelling
- Redness and much pain
- Sharp uric acid crystal deposits in joints, often in the big toe
- Stiffness in joints
- Deposits of uric acid (called tophi) that look like lumps under the skin
- Kidney stones from uric acid crystals in the kidneys.
The big toe is the joint that is affected most often. Other joints that may be affected include the:
You are more likely to have gout if you:
How Is Gout Diagnosed?
The first step in diagnosing the disease is to determine which joints are affected. A physical examination and medical history can help confirm or rule out gout. For example, gout is more likely if arthritis first appears in the big toe.
Blood Test for Uric Acid Levels - A blood test is usually done to measure uric acid levels and detect hyperuricemia. A low level of uric acid in the blood makes a diagnosis of gout much less probable, and a very high level increases the likelihood of gout, especially if patient has symptoms of gout.
Examination of Synovial Fluid - Synovial fluid examination is the most accurate method for diagnosing gout. The synovial fluid is the lubricating liquid that fills the synovium (the membrane that surrounds a joint and creates a protective sac). The fluid cushions joints and supplies nutrients and oxygen to the cartilage surface that coats the bones.
The doctor uses a needle attached to a syringe to draw out fluid from the affected joint. This is called aspiration. Local anesthesia is not used because it can reduce the effectiveness of the procedure. However, the procedure is usually only mildly uncomfortable. Afterwards, there can be some minor discomfort in the area where the needle was inserted, but it usually goes away quickly.
- Are overweight
- Have an enzyme defect that makes it hard for the body to break down purines
- Have had an organ transplant
- Drink too much alcohol
- Eat too many foods rich in purines
- Have family members with the disease
Use of some medicines such as diuretics, aspirin, cyclosporine, or levodopa
The fluid sample is sent to a laboratory for analysis. Testing can reveal the presence of monosodium urate (MSU) crystals, which will nearly always confirm a diagnosis of gout.
Urine Tests - It is sometimes helpful to gauge the amount of uric acid found in a patient's urine
Signs and Symptoms of Gout Include:
Asymptomatic (without symptoms) hyperuricemia refers to condition where there is an increase level of uric acid in the blood but no other symptoms. People at this stage do not need treatment.
Acute gout or acute gouty arthritis refers to the stage where increased levels of uric acid have caused deposit of uric acid crystals in the joint spaces. This causes a sudden onset of intense pain and swelling in the joints, which often become warm and very tender. The attack commonly occurs during the night. When gout first hits, he episodes usually go away within 3-10 days. The next attack may not occur for months or years. Over time, the attacks come more frequently and last longer.
Chronic tophaceous gout usually develops over a long period and over time can cause permanent damage to the affected joints and sometimes to the kidneys. With proper treatment, most people do not reach this stage.
Chronic tophaceous gout
To confirm a diagnosis of gout, your doctor may draw a sample of fluid from an inflamed joint to look for crystals associated with gout.
Nonsteroidal anti-inflammatory drugs (NSAIDs) -
NSAIDs are the medications most often used for the treatment of gout.. They work by reducing inflammation and pain, which decreases swelling and stiffness of the joints. Indomethacin is the most commonly used NSAID but may be more likely than some other NSAIDs to cause stomach problems such as heartburn, ulcers and/or bleeding. Additional NSAIDs used to treat gout include naproxen, ketoprofen and diclofenac. All are available only by prescription.
People who are at risk of stomach problems (e.g. over 65 years, taking steroid type medications or have had an ulcer in the past) should take an extra care medication to protect the stomach (e.g. misoprostol or an acid reducing agent such as omeprazole). Make sure you inform any doctor you might be seeing for a gout attack of your complete medical history and all your medications.
Cortisone – If gout doesn’t go away with the use of an NSAID, your doctor may choose to give you an injection of cortisone into the affected joint. Cortisone is a steroid that’s reduces inflammation and swelling.
Colchicine, which works best when taken within the first 12 hours of an acute attack.
This medication has been around for a long period of time (since the 1800s) for the treatment of gout. It is very effective but tends to cause side effects such as nausea, vomiting and diarrhea after being taken for short time.
Hot and Cold Therapy
Hot and Cold Therapy. Rest and protecting the affected joint with a splint can also promote recovery. Both ice packs and the application of warmth have been found to relieve symptoms.
There are certain measures you can take to reduce the possibility of having an episode of gout. They include:
Plan follow up visits with your doctor.
Take the medicines your doctor prescribes as directed.
Keep a Healthy weight – Sudden or large changes in weight can trigger a gout attack. It is helpful to lose weight if you are overweight, but do so in a health manner (i.e. Talk with a dietitian).
Eat a healthy diet: - You can keep your level of uric acid as low as possible by reducing your intake of food and drink that are high in purines (raw materials that the body uses to make uric acid).
Foods and drinks to avoid include yeast products (beer and baked goods) liver, peas, spinach, coffee and cocoa.
Red meat (beef, pork, lamb), Seafood (anchovies, sardines, herring, fish roe, canned tuna fish, shrimp, lobster, scallops, mussels)
Drink plenty if non-alcoholic fluids – each day: especially water to help remove uric acid from your body.
Exercise regularly – to help strengthen the joints and maintain a healthy weight.
Avoid Joint Injury -
People with gout should also attempt to avoid activities that cause repetitive joint trauma, such as wearing tight shoes.
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