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Gout

Gout: Causes, Symptoms, cost and Treatment

What is gout?

Gout is an inflammatory form of arthritis that develops in people with high levels of uric acid and affects one or more joints in the body. In fact, severe gout can affect many joints in the body together all at once. This condition is known as polyarticular gout. Gout is usually accompanied by the uric acid symptoms of joint redness, swollen joints, joint pain, and a sensation of warmth in the affected joints.

Normal uric acid levels are 2.4-6.0 mg/dL (female) and 3.4-7.0 mg/dL (male), though the values may vary from laboratory to laboratory. When the blood uric acid level rises above 7mg/dL problems such as kidney stones and gout occur.

How does gout occur?

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. If there is an excessive build-up of uric acid in the body and the kidneys are not able to filter it all out naturally, the level of uric acid in the body rises. High levels of uric acid in the blood can cause uric acid crystals to form in the joints. This causes the painful condition called gout.

Who is prone to gout?

Certain people are more prone to gout than others, they include:

  • People who eat a diet high in meat and seafood constantly.
  • People who overindulge in drinking alcohol.
  • People who suffer from medical conditions such as diabetes or high blood pressure.
  • People who have a family history of gout.
  • Women after menopause may develop symptoms of gout since the uric acid levels in women tend to rise after menopause.
  • People who had surgery recently may be susceptible to gout.
  • People who suffer from obesity.
  • People with insufficient kidney function are at increased risk for gout.

What are the causes of gout?

The causes of gout or of high uric acid include:

  • high levels of uric acid in the body
  • a family history of gout
  • certain medicines, which can increase uric acid levels in the body
  • constantly consuming a diet rich in red meat and seafood
  • overindulgence in alcohol
  • starvation and dehydration
  • chemotherapy

What are the symptoms of gout? How is gout diagnosed?

When uric acid levels get high, they can form crystals, which lodge in and around the joints, causing a gout attack. But not everyone with high uric acid levels develop painful gout.

People are more likely to develop gout if they:

  • Are male.

  • Have family members who have gout.

  • Take certain drugs (e.g., water pills, aspirin, cyclosporine, niacin, levodopa).

  • Have another type of inflammatory arthritis, such as rheumatoid arthritis or psoriatic arthritis.

  • Drink more than two alcoholic drinks or two beers a day.

  • Drink a lot of sugary drinks.

  • Are obese.

  • Had gastric bypass or transplant surgery

  • Eat a lot of high-purine foods, such as:

    • Liver, kidney, sweetbreads and other organ meats.
    • Red meats (beef, lamb, pork).
    • Select seafood (anchovies, sardines, mackerel, herring, mussels, scallops, trout, haddock, and tuna)
    • Broths, consommés, gravies.
    • Caviar, roe.
    • Dried peas and beans. - Have high blood pressure; kidneys or thyroid gland that don?t work properly; or a condition that causes cells to turn over quickly (e.g., psoriasis).

Stages of GOUT

1. Before the first gout attack:

There are no symptoms, but uric acid levels are high and crystals are forming in the joints. This is called ?asymptomatic hyperuricemia.?

2. Acute Gout:

Uric acid levels spike or crystals in the joint move around. The attack (flare) may be caused by an injury (like stubbing the toe), alcohol, drugs an infection or illness. The pain usually strikes at night and gets worse over the next 8?12 hours. The symptoms ease after a few days and likely go away in 10 days. Some people never experience a second attack, but many people will have a second attack within a year.

3. Interval Gout:

This is the time between attacks. Although there?s no pain, the gout isn?t gone. Low-level inflammation may be damaging joints.

4. Chronic Gout:

Gout attacks happen more often for people who have high uric acid levels for 10 years or more. Pain comes and goes more frequently.

Diagnosis

If you suspect that you suffer from symptoms of gout you can visit your family physician or any general doctor. A general physician usually treats gout, however, if your condition is too severe he may refer you to a rheumatologist.

Gout may be difficult to diagnose because the symptoms can be vague and could be from other conditions. The following tests could be suggested by your doctor to diagnose gout:

  • Joint fluid test: To conduct this test your doctor draws a sample of synovial fluid from your joint. The fluid is examined under a microscope for uric acid crystals. The joint fluid may also be cultured to see if bacteria grow from it.
  • Blood test: A blood test will help to measure the levels of uric acid and creatinine in your blood.
  • X-ray imaging: X-rays of joints can be helpful to rule out other causes of joint inflammation.
  • Ultrasound: Urate crystals can be detected in a joint with the help of an ultrasound.
  • Dual-energy CT scan: This test though not often performed, can detect the presence of urate crystals in a joint, even when it is not acutely inflamed.

What are the complications of gout?

Some complications of gout include:

  • Kidney stones
  • Tophi, which is a condition that occurs when deposits of urate crystals form under the skin in nodules in areas of the body such as fingers, hands, feet, elbows or Achilles tendons along the backs of your ankles.
  • Joint damage which can occur due to recurrent gout

What is the treatment for gout?

Medical Treatment for Gout

Medical treatment for gout usually involves medicines. Your doctor will prescribe medicines based on your current health condition.

Medications for gout are usually prescribed to treat prevent future acute attacks and reduce the risk of complications.
Treating an Acute Gout Attack

Here are the steps for getting the pain and swelling of a gout attack under control as quickly as possible:

  • Call your doctor and make an appointment.
  • Ice and elevate the joint.
  • Drink plenty of fluids (no alcohol or sweet sodas).
  • Reduce stress, which can worsen the attack.
  • Ask friends and family to help you with daily tasks to ease stress on joints.

Exercise

People often wonder how can they exercise if they suffer from gout since the joints are so painful and sensitive.

However, keep in mind inactivity can make you less flexible, and weaken your joints and muscles. This can result in bone loss and further intensify the symptoms of gout. Exercising will keep you fit and healthy and help you to maintain an ideal body weight. Exercising will increase your energy and make your bones, joints and muscles strong. Else if you suffer from gout the bones and joints deteriorate over time.

Before deciding on an exercise regimen make sure to consult your doctor and find out if the kind of exercises you are interested in are suitable for you.

Some of the exercises that you can opt for are yoga, Tai Chi, low impact aerobic exercises, dancing, cycling, swimming. Diet

Drink lots of water and avoid alcohol, beer, high-purine foods and sugary drinks to help reduce uric acid buildup.

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  • Chandrashekharan says:

    My friend's uncle has been suffering from gout since a year now. We tried multiple suggestions from various local doctors but didn't get the results positive. A website suggested Dr. Kishore's. He recommended colchicine (Colcrys, Mitigare), a type of pain reliever to reduce gout pain. To reduce uric acid levels uncle was to take coffee and increase intake of vitamin C, limiting intake of foods high in purines, such as red meat, organ meats and seafood,exercising regularly and losing weight were certain activities advised too. Uncle is at relief now. Been 3 years after his treatment. Thank you DR. Kishore.