What is Gout?
Gout is inflammation of joint associated with increased levels of uric acid in blood (Hyperuricemia) and deposition of uric acid crystals in joint space. Gout is the most common arthritis in elderly population. Increasing incidence of gout in Asian population is related with increase in westernization of their diet. Men are affected more than women.
Serum uric acid levels depend upon balance between total intake and excretion of uric acid by kidney (via urine) and intestines (via stools).90% of people with gout have problems related to excretion of uric acid. This might be related to genetic variations in genes involved in uric acid excretion.
Hyperuricemia is increased levels of uric acid in blood. Normal Uric acid levels are 2.4-6.0 mg/dL (female) and 3.4-7.0 mg/dL (male). Normal values will vary from laboratory to laboratory.
- Acute gout: Patient develops joint swellings suddenly. Usually patient has asymptomatic Hyperuricemia. This condition takes over 2 weeks to develop
- Chronic interval gout: Patient gets sudden joint pains called as acute attacks in a pre-existing mild arthritis, example, worsening of arthritis in winter season. In this condition patient already had joint damage
- Chronic polyarticular gout: Seen in elderly people who are on longstanding diuretic treatment or in renal failure. There is involvement of multiple joints for prolonged period of time
- Tophaceous gout: Besides arthritis patient also develops, nodular swellings under the skin called as Gouty nodules
How common is Gout?
- Gout is five times more common in men than women
- Old age people are at high risk
- Post-menopausal women are at high risk than menstruating women
- More than 10 million cases per year in India
What are the symptoms of Gout?
- Swelling of one joint (mono-arthritis) associated with pain and stiffness
- Tenderness around joint space
- Increased temperature of skin over joint than surrounding
- Nodules (tophi) of uric acid under skin at pressure points like elbow, great toe, etc.
What are the causes of Gout?
Gout is caused by excess uric acid in the body.
Who’s at a higher risk of Gout?
- Obese people
- Post-menopausal women
- People with chronic kidney disease
- Longstanding thiazide diuretic treatment (for hypertension) or low dose aspirin (for stroke)
What are the complications with Gout?
- Permanent joint damage
How is Gout treated?
- NSAIDs (Non-steroidal anti-inflammatory drugs) in high doses rapidly reduce pain and swelling. These should be first medication to be given in acute attack. Example: Diclofenac, Ibuprofen, Naproxen
- In patients with kidney damage, NSAIDs are not advised. Alternative treatment options are Colchicine or low dose steroids
- Agents which reduce Serum uric acid levels: These should not be started immediately after attack as frequent changes in uric acid levels may flare-up the disease.
Allopurinol (Drug of choice)
- Biologics: These are newer drugs. Examples are Anakinra and Canakinumb
What are the dietary advices for people with Gout?
- Avoid some fish, seafood and shellfish, including anchovies, sardines, mackerel, scallops, herring, mussels, codfish, trout, and haddock
- Avoid sweetbreads and some meats such as bacon, turkey, veal, venison, liver, beef kidney and brain
- Avoid alcoholic beverages especially beer as it contains large amount of fructose and purine
What are the lifestyle changes required for Gout?
- Dietary changes: Limit alcohol intake and foods rich in purines such as fatty food and meat because they increase uric acid. Increase the intake of Vitamin C
- Reduce stress: Stress may increase the chances of a gout attack. Do things that help you minimize stress and help you manage it better
- Exercise often: Exercising helps in managing weight which is an important part of treating gout. It also helps prevent future gout attacks.
- Get enough rest: Rest is important for the body to repair itself and recover. It is important to ensure that you get minimum of eight hours of sleep. Resting can help repair joints faster.
How to take care of someone with Gout?
- Help them with daily activities in case of a gout attack as joint movements can be painful for them
- Ensure they follow the correct diet to manage Gout
- Help them exercise every day
- Take them to their doctor’s appointments
- Be there for them
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