What is Gout?

What is Gout?

Gout is a potentially debilitating form of arthritis, which usually begins with sudden attacks of intensely painful single joints that are swollen, red, warm, and tender.

How does one know if he/she has gout?

The first attack most commonly affects the big toe, but can also involve ankles, heels, knees, wrists, fingers, and elbows. Initially, attacks are infrequent and intervals between attacks may last for years. Over time, the attacks become more frequent, longer in duration, and involve more joints. Repeated attacks can damage affected joints if the disease is not controlled.

Who can develop gout?

There are several factors that put people at greater risk for developing gout. These include:

• Sex and age. Gout predominantly occurs in males and postmenopausal women; most common between the ages of 30 and 60.
• Gout is strongly linked to obesity, hypertension, hyperlipidemia (high levels of fat and cholesterol in the blood), and diabetes
• Family history

What happens when you have Gout?

Gout results from the build up of too much uric acid in the body. When tissues become supersaturated, uric acid precipitates forming needle-like urate crystals. These crystals then deposit in and around the joints inducing irritation and inflammation leading to an attack.

Uric acid can also deposit in the urinary tract causing kidney stones. It can also accumulate under the skin forming tophi. The excess uric acid in the body happens either due to overproduction or, more often, the kidneys cannot sufficiently eliminate uric acid from the body.

Certain foods and drugs may increase uric acid levels, which include the following:

• Internal organ meat (liver, kidney, brain), red meat
• Shellfish, bagoong, dilis and sardines
• Alcohol, in excess especially beer
• MedicatinsL diuretics (hydrochlorthiazide), anti-TB (pyrazinamide), immunosuppressant (cyclosporine)

How is gout diagnosed?

Rheumatologists are doctors who are experts in diagnosing and treating arthritis and other diseases of the joints, muscles and bones. They will usually suspect gout in a patient with sudden extreme single joint pain and swelling, followed by symptom from free intervals. The definitive diagnosis of gout is made by extracting fluid from the affected joint and examine it for urate crystals, this may not always be necessary.

Blood uric acid levels can be measured but may be normal or even low during attacks, and people can have elevated uric acid levels and not have gout.

What are the available treatment options?

Gout is managed as follows:

1. Treat the acute attack
2. Provide prophylaxis to prevent attacks
3. Lower uric to prevent flares and tissue deposition of crystals

Treatment of Acute attacks

• Colchicine is effective especially if given within 24. In between attacks, it may be maintained as prophylaxis.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) can also decrease pain and inflammation.
• Corticosteroids – It can be given either orally or by injection into the joints.
• Non-pharmacological remedies such as rest and ice/cold compress can also be applied.

Lowering Uric Acid Level

Allopurinol is the drug most often used. It decreases uric acid levels by blocking uric acid production. Febuxostat is an alternative especially for patient allergic to allopurinol.

Probenecid helps the kidneys eliminate uric acid but are only for patients with good renal function.

Lifestyle and Diet

• Controlling weight is recommended. However, abrupt reduction or swings in weight may trigger a flare of gout.
• Regular exercise may help reduce uric acid levels.
• Limit alcohol intake and meals rich in purines (e.g. meat, seafoods). Purines are broken down into uric acid.
• Low-fat dairy products may help lower uric acid levels.
• Drink plenty of water (12 8oz glasses/day)
• After an attack, try to recall/list foods eaten the day before to establish your own gout triggering food, so it can be avoided.

What are the possible complications of Gout and high uric acid level?

• Joint damage
• Affect renal function (kidney stones, urate nephropathy)
• Soft tissue urate deposits (tophi)

At The Medical City, we have a complete roster of competent rheumatologists, orthopedic surgeons, physiatrists who can assess and manage patients with gout.

For more information, you may contact us:

The Medical City

Section of Rheumatology

Internal/Medicine Office

Tel. no.: (632) 988-1000 / (632) 988-7000 ext. 6287

Email: rheumatology@themedicalcity.com

References:

1. American College of Rheumatology. (2013, February). Systemic Lupus Erythematosus, from http://www.rheumatology.org/Practice/Clinical/Patients/Diseases_And_Conditions/Systemic_Lupus_Erythematosus_(Lupus)/
2. Firestein, G. (2008). Kelley’s Textbook of Rheumatology (8^th Ed.), Philadelphia, PA: Saunders.
3. Klippel, J. (2008). Primer on Rheumatic Diseases (13^th Ed.). New York: Springer.
4. Department of Medicine: Section of Rheumatology, The Medical City

Note: This information is not intended to be used as a substitute for professional medical advise, diagnosis or treatment.   If you or someone you know have any of the symptoms mentioned above, it is advisable to seek professional help.