Gout

Gout is a form of arthritis characterized by sudden attack of severe pain and swelling in joints, particularly the toe joint. 

It is caused by the deposition of uric acid crystals in the joint. Gout is diagnosed by analyzing the fluid from the inflamed joint. Medications that lower the levels of uric acid in body help to treat chronic form of gout. 

If left untreated, it may lead to permanent damage to joints and kidney problems. Although gout can affect anyone, it is most commonly found in men when compared to women. 

Women become more susceptible to this form of arthritis after menopause. Treatment help in alleviating the symptoms and in preventing recurrence.

Characteristic symptoms of gout include: 

• Sudden onset of pain in the joints
• Swelling in joints
• Warmth in the affected area
• Reddishness in the joint

Severity of pain depends on the extent of inflammation in the joint. Gout usually affects one joint, most typically the big toe. It may also affect knees, ankle, foot, wrist, hands, and elbow. 

The affected joint often becomes very sensitive, and patients may experience pain even with a slight movement or touch of the area. As the condition progresses and becomes severe, multiple joints may be affected by arthritis. 

Joint mobility is considerably affected with the progress of the condition. 

Tophus, a hard nodule formed by the deposition of uric acid crystals, is another characteristic feature of gout. 

The deposition is found just under the skin, and may occur in various parts like elbow, upper ear cartilage, and other joints. 

Tophus represents a significant overload of uric acid in the body. Kidney stones also may be a symptom of gout as deposition of uric acid crystals in kidney result in kidney stones. 

Gout is caused by accumulation of uric acid crystals in the joints. Buildup of urate crystal results in inflammation and severe pain in the affected region. 

High levels of uric acid in the blood results in urate crystal formation. Uric acid is produced as a byproduct of purine metabolism. 

Purines are substances normally found in the body and also in certain foods. Steak, organ meat, seafood, alcoholic beverages, and drinks sweetened with fructose increases the level of uric acid in the body. 

Factors that increase the level of uric acid in the body, enhances the risk of gout. This includes: 

• Diet – diet rich in purines like seafood and organ meat increases the level of uric acid in the body.
• Obesity – the amount of uric acid produced in body is higher in obese people. Moreover, kidneys are unable to filter all the uric acid from the body for elimination. 
• Certain conditions – certain conditions like hypertension, diabetes, metabolic syndrome, and heart and kidney diseases increase the risk of gouty arthritis.
• Certain medications – thiazide diuretics, and low dose aspirin may increase the risk of gout by increasing the level of uric acid in the body. 
• Family history – family history of gout increases the risk of the condition.
• Recurrent surgery – the risk of gout is more in people who have undergone a recent surgery or trauma. 

Gout is more common among women. The risk of gout increases with menopause in women. 

Laboratory tests and imaging techniques are used in the diagnosis of gout. Presence of urate crystals in the joint is observed by joint fluid test, a procedure in which fluid from the affected joint is analyzed. 

Blood test measures the levels of uric acid and creatinine in blood. X-ray images are used to differentiate other conditions that result in joint inflammation. 

Urate crystals in the joint is visualized using ultrasound and dual energy CT scan.

Medications for treating gout depend on the health of the patient and the patient’s choice. 

• Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen sodium prevents acute attacks and recurrence. 
• Colchicine reduces pain associated with gout. This drug has many intolerable side effects. 
• Corticosteroids are prescribed to control pain and inflammation in gout. They are available in tablet and injection form. 
• Xanthine oxidase inhibitors like allopurinol and febuxostat are suggested to prevent gout-related complications. These drugs lower the levels of uric acid in blood. 
• Probenecid helps to improve the elimination of uric acid by kidneys. This lowers the levels of uric acid in blood, and also the risk of gout. 

Future gout attacks can be prevented by: 

• Having plenty of fluids 
• Limiting the use of alcohol 
• Having low-fat dairy products
• Limiting the intake of meat, fish, and poultry
• Maintaining an optimum body weight. 

A few alternative and homeopathic remedies are used to reduce the symptoms of gout.

Certain foods are found to be effective in reducing the symptoms of gout. Coffee, vitamin C, and cherries are the most important among them. 

Relaxation techniques like yoga and meditation will help in controlling pain associated with gout. 

Colchicum, arnica, belladonna, berberis vulgaris, ledum, ammonium phosphoricum are used in homeopathy for treating symptoms of gouty arthritis.

Lifestyle changes also help to control the symptoms of gout. Having plenty of water and non-alcoholic beverages keeps the person well hydrated. 

Limiting the intake of alcoholic beverages helps to decrease the risk of gout episodes. Diet less in purines, the component which produces uric acid, is also important in controlling gout. 

Maintaining a healthy body weight by regular exercise and healthy diet improves the overall health and reduces the risk of arthritis.

There are several complications associated with gout.

Some people may have recurrent episodes of gout several times in a year. This may lead to degeneration of the joint. 

Formation of tophi in different parts of the body is another complication associated with gout. Accumulation of uric acid crystals in the kidney lead to kidney stones.