Gout is a condition which affects joints causing severe pain, swelling and redness. The joint pain usually come on very suddenly causing difficulty in walking and doing day to day activities. The painful episode may last for five to ten days. To start with it usually affects one joint but sometimes a number of joints can be involved (which is known as polyarticular gout). Although it can affect any joint in the lower limb most common joints affected are the joint at the bottom of the big toe the foot (small joints in the middle of the foot), ankle, knee etc.
Gout usually occurs in attacks. The attacks may be compared with the episodes of Tsunami as it comes very suddenly, very painful, goes away after 1 wk – 2wk very quietly. An attack typically develops quickly over a few hours. It usually causes severe pain in one of the joints of Lower limb very often the great toe. The base of the big toe is the most commonly affected joint. The pain is so severe that even the weight of bedclothes can hurt. Walking can be very painful. Sometimes doctor may mistakenly think this as fracture or sprain.
Sometimes it can affect two or more joints. Affected joints usually swell and the nearby skin may look red and hot (inflamed). Untreated, a gout attack may last several days but usually goes away completely within 10 days. Less severe attacks can occur which may be mistaken at first for other forms of arthritis. Weeks, months or even years may go by between attacks.
Gout is a disease of disordered uric acid metabolism. When uric acid is produced in excess or is unable to get excreted in urine , it gets deposted in the body, and needle‐like urate crystals deposit in the joints. These uric crystals cause inflammation of joints causing joint pain. Certain nonvegeterian foods may raise uric acid levels and lead to gout attacks. These include Shellfish, gravies, red meat, soups and organ meats such as liver are high in purines. Besides that taking Alcohol in excess or Sugary drinks and foods that are high in fructose may precipitate gout attacks.
Some medications have the potential of increasing uric acid level. So they have to be avoided in Gout patients. They include certain diuretics (“water pills”) such as hydrochlorothiazide which is also used in treatment of blood pressure, (mmunosuppressants used in organ transplants such as cyclosporine and tacrolimus etc.
Uric acid also can deposit in the urinary tract, causing kidney stones or kidney causing renal failure.
- Gout is a type of arthritis which is caused by excess uric acid in the bloodstream.
- The symptoms of gout are related to the formation of uric acid crystals in the joints and the body’s response to them.
- Gout very typically affects the joint in the base of the great toe.
- Gout attacks occurs in episodes at least in the early part. The attacks often occur without warning in the middle of the night.
- Most gout cases are treated with specific medications.
- If treated under a rheumatologist from early stage, patients can have a normal life.
- The attacks or episodes of joint pain are so typical in Gout, it can be diagnosed from patient history correctly in 95% cases. But some tests are usually done in doubtful cases or to monitor treatment.
- Blood level of Uric acid usually helps to monitor treatment response.
- In doubtful cases, a needle may be put into the joint to take off some fluid. And examined under microscope for evidence of urate crystals in the fluid .
- X-rays of the joints can sometimes show up changes that would suggest gout
- Now a days Ultrasound of joints are used to detect these uric acid crystals before they cause damage and picked up in the X ray.
- Blood tests also done to find out associated conditions like kidney disease, heart disease, high cholesterol levels etc
During acute attack , raise the affected limb (usually a leg) to help reduce the swelling by reclining on a sofa with your leg up on a cushion. An ice pack (or a pack of frozen peas) application on inflamed joint may ease the pain until the gout treatment medicines (below) start to work:
The initial attack of gout can be controlled with pain killers or anti-inflammatory tablets like naproxen or indomethacine. These medicines has to be taken with a gas medicine as they can cause gastritis. If there is kidney failure, Steroids such as prednisolone may be tried by your physician. Injection of a steroid preparation into the joint may be very relieving if there is fluid in the joint causing sevre pain.
Your doctor will start you on a tablet called colchicine to prevent future attacks of gout.
A number of tablets are available to decrease the blood uric acid level which are called as hypo uricemic drugs . the commonly used drugs are Allopurinol and febuxostat. These work by lowering the levels of urate in the blood. Once the urate falls beneath a certain level the frequency of attacks should reduce or stop altogether. The treatment dose will be increased until a satisfactory level of blood urate is achieved. DO NOT stop it unless you are told to by your doctor. These may cause Side effects which are rare but include rash, headache and nausea. If you get any of these stop the tablet and seek advice from your doctor immediately. If the treatment is stopped without doctor consultation, the urate levels are likely to rise and gout will come back. Anti-inflammatory painkillers
In the initial stage, a sudden-onset attack of gout usually resolves within 3-10 days. About 60 percent of patients who have one acute attack will have another acute attack within the following year. Repeated acute attacks and long-lasting (chronic) gout may lead to progressive damage of the joint causing severe bone deformity and joint damage. Besides the joints, persistence of high serum uric acid level in the body may cause kidney stone, kidney failure and high risk of heart disease.
At OARC, we offer holistic care to patients suffering from all kind of arthritis and autoimmune diseases by our renowned rheumatologist.
Because of chronic illness of the disease, we spend some time with the patient helping them to know about their disease, and demystify the myths regarding the disease and treatment.
We have collaboAStion with NABL accredited laboAStory where all kind of blood tests can be done at reasonable costs.
We also have patient support system where patient can approach in case of any emergency.
We believe in a friendly relation with patients so that they can share all their sufferings and get the best possible treatment.