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Gout

Gout


  • Gout is otherwise known as "the disease of kings" or "rich man's disease".
  • Gout is characterized by sudden, severe pain, redness and swelling of joints, often the joint at the base of the big toe.
  • Men are more likely to get gout, but women become increasingly susceptible to gout after menopause.
  • An attack of gout can occur suddenly in the middle of the night to such an extent that not able to put down the foot on the floor.
  • Gout is caused by the deposition of crystals of uric acid in a joint.
  • Many people with high levels of uric acid in their blood but never get gout.
  • But when uric acid levels in your blood are too high, the uric acid may form hard crystals in your joints.
  • Whenever there is kidney disease then excretion (removal) of uric acid by kidney decreased because of which increase of uric acid is seen in this group of individual.

Signs and symptoms of Gout include:

  • Intense joint pain – Big toe is the most common joint affected but it can occur in your feet, ankles, knees, hands and wrists. The pain is likely to be most severe within the first four to 12 hours after it begins.
  • Inflammation and redness - The affected joint or joints become swollen, tender, warm and red.
  • This joint pain comes in episodic or phase wise manner. Several months may pass before another attack.
  • Each episode stays for around 5-10 days
  • In between attack patient is asymptomatic
  • If not treated them the chances of another attack in more.
  • Sometime gout also can involve multiple joints.
  • Often gout is associated with kidney disease and metabolic syndrome such as diabetes & obesity.

Diagnosis:

  • Joint fluid test – Synovial fluid from the joint might reveal uric acid crystal under microscope examination.
  • Blood test – Blood uric acid might be high:
    o Blood test results can be misleading, though. Some people have high uric acid levels, but never experience gout. And some people have signs and symptoms of gout, but don't have unusual levels of uric acid in their blood.
    o If during the attack time blood uric acid is normal, then again repeat it after 2wks of gout attack.
  • X-ray imaging - Joint X-rays can be helpful to rule out other causes of joint inflammation.
  • Ultrasound - Musculoskeletal ultrasound can detect urate crystals in a joint or in a tophus.

Treatment:

  • For pain relief during the time of Attack-Colchicine, NSAID (Indomethacin, Naproxen, Eterocoxib etc.) or Steroid in case of kidney disease.
  • Uric acid lowering Drugs-Allopurinol, Febuxostat.
  • Gout and High blood Pressure-Preferred antihypertensive are losartan, telmesartan and Amlodipine.
  • Gout with hyperlipidemia- Fenobrate is preferred.
  • Common medication increases uric Acid-Thiazide diuretic, Pyrazinamide and cyclosporine.

DIET:

  • The biggest misconception for Indian population is to avoid dals, nuts, dairy products, vegetables like tomato, cauliflower, spicy food etc. Normally patients survive only on boiled vegetable but despite so much sacrifice on eating, they continue to have gout attacks.
  • Egg white, dairy protein & plant protein do not tend to increase gout risk.
  • Higher levels of purine consumption in form of meat and seafood do increase the risk of gout.
  • High purine foods like liver, red meat and certain sea food should be avoided.
  • Avoid fructose sugar, anabolic steroids and other potentially harmful unregulated supplements.
  • Maintain good amount of water intake.

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