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Gout
Overview

Gout is a joint disease caused by an abundance of uric acid in the blood. Uric acid is a waste product that our body usually eliminates. If however there is decreased excretion or increased production of this metabolite it predisposes individuals to gout. Uric acid turns into a crystal form known as monosodium urate which can deposit anywhere in the body. Most often the crystals deposit in the joints which causes a localized inflammation. Resultant symptoms of severe pain are experienced by the patient along with redness and swelling of the involved area. The classical site affected by gout is the big toe but attacks can affect other joints as well.
Gout is one of the oldest forms of arthritis in recorded history. Gout has been referred to as “rich man’ disease” because of its association with eating meat, an item usually consumed by the wealthy in historical times. Both King Henry VIII of England and King Charles I of Spain are said to have been afflicted by gouty arthritis.

Signs and Symptoms

Signs and Symptoms

Gouty arthritis is characterized by symptoms of pain that start suddenly and eventually diminish, even in the absence of treatment. Between the flares of pain the affected joint will be symptom free. The involved joint space and the tissues surrounding it are swollen, red and feel warm to the touch. A variety of symptoms can result depending on where in the body the monosodium urate crystals settle. A collection of crystals can form a mass known as a tophus and deposit in soft tissue including that of the skin where it can be felt as a fixed bump. Similarly this can happen in cartilage and frequently involves the ear. High levels of uric acid can also put individuals at risk of forming kidney stones in which case the patient would present with bouts of severe abdominal pain.

Diagnosis of Gout

Diagnosis of Gout

To help reach a conclusive diagnosis of gout, arthrocentesis is performed. This procedure involves aspiration of fluid from the joint space. This fluid is then tested to determine the amount of different white blood cells it has, stained, and cultured. The sample is also examined under a microscope using a polarized light, which aids in visualization of the characteristic needle shaped crystals present in gout.

Treatment of Gout

Treatment of Gout

This entails therapy aimed at relieving symptoms of a sudden attack as well as the necessary steps for avoidance of future episodes. For patients experiencing acute symptoms, treatment includes utilization of drugs that counter act the ongoing inflammatory process. Non-steroidal anti-inflammatory drugs also known as NSAIDs are used and include indomethacin and ibuprofen. In individuals who cannot tolerate these drugs, colchicine or glucocorticoids are given. Long-term preventative therapy is started after the initial attack subsides and is based on lowering the levels of uric acid in the body. This goal is achieved by drugs such as allopurinol, which inhibit a specific enzyme involved in the formation of uric acid.

Prevention of Gout

Prevention of Gout

Lifestyle modifications based on lowering the uric acid level in the blood are highly recommended to prevent future flare ups. Food and drink items rich in purines should be consumed in limited quantities because as they are metabolized in the body they lead to the production of uric acid. Purine rich foods include meat, alcohol and anything with high fructose corn syrup. Reduction of weight in overweight patients has helped with improvement of symptoms.

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