A Simple Guide to Gout

I attended the wedding banquet of my best friend 2 days ago. The dishes served at his wedding banquet were scrumptious ranging from king crabs to lobsters. On top of that, there was a free flow of alcoholic drinks. I was happy for him as he was my closest friend and frankly I ate and drank quite a lot. But I stop short of embarrassing myself by drinking too much to get myself drunk. I could still drive home safely but as I reach home, there was a sense of lightness in me and I accidentally knocked into my chair. As it was just a minor knock without any abrasion, I quickly clean up and got to sleep. However, the next day I woke up with my toe feeling hot, tender, swollen and red so much so that the weight of my blanket is unbearable.

This is a typical story that is given by patients who had suffered from gout attacks before. So what is gout exactly all about? Read on to get a simple idea of what is gout, what causes it, who are the persons at risk, what can precipitate attacks and how to prevent further attacks. To start with, gout is define as a disorder of purine metabolism characterized by hyperuricaemia (excessive blood levels of uric acid in the blood) and the subsequent deposition of monosodium urate crystals in joints hence leading to recurrent attacks of acute synovitis.

Uric acid results from the breakdown of purines, a substance found not only in many foods but also in our human tissue. Hyperuricemia occurs under two conditions namely overproduction of uric acid or under excretion of uric acid. Overproduction can result when there is over consumption of high purine foods such as liver, anchovies, mackerel, herring, crustaceans, red meat such as beef, mutton, etc. However, hyperuricemia can also result from certain medical conditions like side effects of drugs such as diuretics and fibrates and excessive breakdown of cancer cells during chemotherapy treatment.

So what happens when there is hyperuricemia? Not all persons with hyperuricemia develop gout. However normally, excessive uric acid in the blood will lead to uric acid crystal formation. These crystals are subsequently deposited in minute clumps in connective tissue; the commonest sites are the small joints of the hands and feet. Then possibly as a result of local trauma, the needle like crystals are dispersed into the joint and the surrounding tissues, where they excite an acute inflammatory reaction thus giving rise to all the signs and symptoms of an acute attack of gout. With time, uric acic crystals then accumulates to form clumps of chalky material, or called tophi which usually appears as lumps under the skin around the joints and at the rim of the ear. Late complications include cartilage degeneration (due to repeated inflammation), renal dysfunction and uric acid kidney stones.

Gout is more common in Caucasian and also more common in men than in woman, with some studies suggesting a ratio of 20 to 1. There also appears to be some genetic predisposition to gout with 18 percent of people having a family history of the disease. Precipitating factors for an acute attack includes alcohol binges, consumption of high purine foods as mention earlier and being overweight.

Now we look at how gout is treated. The 3 goals of treatment are to ease the pain during an acute attack, to prevent future acute attacks and to prevent long term complications such as tophi formation and kidney stones. During an acute attack, resting the affected joint and large doses of non steroidal anti inflammatory agent (NSAIDS) is the usual treatment regimen. Examples of NSAIDS include indomethacin and naproxen. Otherwise, anti inflammatory steroids such as prednisolone can also be used. With these treatments, improvement usually begins within a few hours and the attack usually completely goes away within a week or so. However, there are instances when even these drugs are ineffective and your doctor may then consider giving you colchicine. This is only effective when taken within the first 12 hours of the acute attack. Side effects of this drug include nausea, vomiting, stomach cramps and diarrhea.

The next part of treatment is to prevent future attacks and long term complications. Needless to say as with all chronic medical conditions, a modification of lifestyle is necessary. In patients with gout, simple measures such as losing weight, cutting out alcohol, ensuring adequate intake of fluids especially water and reducing the consumption of purine rich food to no more than 6 ounces per day is necessary. Doctors may also consider changing your medication for other medical conditions especially if you are on thiazides (a drug for hypertension). Allopurinol, a xanthine oxidase inhibitor (xanthin oxidase is an enzyme that enhances the breakdown of purine into uric acid) is also use for treatment of chronic gout. However, it should never be given during an acute attack as they can actually precipitate an acute attack. The other drug is probenecid which works by enhancing the excretion of uric acid from your body via the kidney provided that your renal function is not impaired.

So now that you know what gout is all about, seek treatment early if you have an acute attack as it is a treatable condition and most importantly live a healthy lifestyle by maintaining a healthy balance diet and exercise that will not only keep out gout attacks but other diseases such as hypertension and diabetes as well.