Gout – What is it and what causes it?

The term gout is derived from the Latin word gutta and French gote which means a drop. In ancient times, it was thought that gout was caused by drops of viscous humors that oozed from blood in to the joints. In reality, this assumption was not very far from the truth. When a person experiences the symptoms of a gout attack, it means that there is accumulation of uric acid in the blood and formation of uric acid deposits in the joints.

Gout is a complex disorder. It occurs more commonly among men and can occur more commonly in women after menopause. The uric acid levels are higher in case of men when compared to women.

Gout – Symptoms

The indications and symptoms of gout are usually acute. They appear all of a sudden without any warning. A lot of people experience such attacks during night.

* Extreme pain in the joints – The person could experience pain in his hands, ankles, wrists, feet or knees. Usually, the big toe is affected (podagra). A lot of people express that the affected area is warm or hot. The fluid sacs that cushion the tissue (bursae) could inflame (bursitis). If it happens in the elbow, it is referred as olcranon bursitis, whereas in the knee, it is referred to as prepatellar bursitis.

* Gradually fades away – An attack could last for more than a week if not treated. It gradually fades in the subsequent week or two.

* Itchy and peeling of skin – As the gout reduces, the skin surrounding the affected area could get itchy and may peel off. After it subsides, the person would feel alright.

* Redness and inflammation – The person will probably suffer from red, tender and swollen joints particularly in the areas where most pain is experienced.

* Red or purplish skin – The affected area could turn red or purplish, which makes the person believe he has an infection.

* Fever – Some people have high temperatures during an attack.

* Reduced flexibility – The use of the affected joint might be difficult and could result in limited mobility.

* No symptoms – it is possible that few people do not experience any symptoms. In such cases, it could lead to chronic gout.

* Nodules – The gout could initially appear in the form of tophi (nodules) in the hands, elbows or ears.

Gout – Causes

The uric acid levels in your blood increase till the level becomes extreme (hyperuricemia) and results in the build up of urate crystals around the joints. This causes severe pain and inflammation in case a gout attack occurs.

When there is a break down of chemicals known as purines in the human body, it generates uric acid. Purines are found naturally in your body and can be obtained in food, for example, organ meats, asparagus, anchovies, herring and mushrooms.

Generally, uric acid dissolves and enters the urine through the kidneys. But, in case the body produces too much uric acid or in cases where the kidneys are not excreting sufficient uric acid, it accumulates. This build up leads to sharp urate crystals that appear like needles. They build up in the joints or surrounding tissue, causing inflammation, pain and swelling.

Amazingly, hyperuricemia is usually found in a lot of people who do not develop gout. Scientists are not entirely sure regarding the causes of hyperuricemia. Definitely, there is a genetic factor as a person whose close relatives have hyperuricemia is more probable to developing it himself.

The following reasons are known to cause a gout attack and could possibly be the reasons for gout:

* Obesity
* Extreme alcohol consumption, particularly beer
* Exceedingly low-calorie diets
* Diet that is high in purine foods, for instance meat, meat organs and seafood
* Regular use of aspirin
* Regular use of diuretic medicines
* Regular use of niacin
* Quick weight loss
* Drugs used by transplant patients, for example cyclosporine
* Chronic kidney disease
* Psoriasis
* High blood pressure (hypertension)
* Tumors
* Hemolytic anemia
* Myeloma
* Lead poisoning
* Surgery
* Lesch-Nyhan syndrome
* Hypothyroidism
* Kelley-Seegmiller syndrome

Gout – When to see a doctor?

In case you experience a sudden and severe joint pain, consult your doctor. In case it is not treated in time, gout could gradually worsen over a period of time. In case your joint is hot and inflamed and you also have a temperature, seek medical attention immediately, the symptoms may be that of an infection.

Gout – How to test for it?

After examination, your doctor might require the performance of the following tests:

* Blood test – This is to measure your uric acid levels. But this test is not decisive. Some people may have high levels of uric acid and not have gout symptoms; whereas few others having gout symptoms may not have high uric acid levels in their blood.

* Joint fluid test – in this test, a needle is inserted to gather fluid from the affected joint. Then this liquid is examined under a microscope to ascertain if there is presence of urate crystals.

Gout – Complications

Usually, gout does not lead to any additional problems. But, some of the likely problems are:

* Recurrent gout – Though a few people only get one attack, and do not experience any more attacks, some people might have recurring attacks. Druga are available that help in reducing the number of recurring attacks or even to eradicate them.

* Advanced gout – In case gout is not treated, urate crystals could form under the skin in nodules. They are referred to as tophi. They could swell and become tender every time the person has a gout attack, but are otherwise not painful.

* Kidney stones – In a person suffering from gout, urate crystals could gather in the urinary tract. This results in formation of kidneys stones. Drugs are available that can lessen the chances of developing kidney stones.

* Damage to joints – In case the tophi (nodules) happen to inflame, it might lead to damaged joints.

* Further spreading – It is possible that the gout might spread to other joints.

Gout – Treatment

1. Medication

Usually, gout is treated with medications. These can include:

* NSAIDs (nonsteroidal anti-inflammatory drugs) – These drugs aid in combating pain and inflammation. Naproxen and Ibuprofen are NSAIDs. Patients who take this drug are more prone to risks such as stomach pain, bleeding and ulcers. Usually, these side effects are a result of taking these drugs at higher dosage than prescribed.

* Colchicine – This is an effective drug for gout. But, a lot of patients could suffer from vomiting, nausea or diarrhea on taking this drug. Colchicine is usually given to people who are not able to take NSAIDs.

* Steroids – These could help to fight inflammation as well as to relieve pain. This medication could be taken orally or it can be injected exactly into the joint. Few people taking steroids might experience poor wound healing, a thinning of bones whereas other cold suffer from weak immune systems that makes it difficult to resist infections. Usually patients who are not able to take either NSAIDs or colchicines are given steroids.

2. Self Help

Some of these measures could aid in easing the swelling and pain:

* Limbs should be raised and rested.

* Few people make use of a splint to immobilize the joint.

* Do not perform vigorous exercises.

* Maintain the joint cool. You could apply an ice pack on the joint; a bag of frozen vegetables that is wrapped in a towel could also help. Never apply anything cold on the skin directly as it could harm your skin. Let the temperature of the affected area come back to normal before you intend to repeat this cooling process.

* Never cover the joint.

Gout – Prevention

1. Medications

There are a few drugs that can help lessen the risk of potential gout attacks. These medications are normally taken subsequent to an attack:

* Reducing the uric acid production – Allupurinol decreases the quantity of uric acid produced by your body. This in turn lessens the risk of having an attack from reoccurring. Some people taking this drug could have side effects that include a low blood count and rashes.

* Effective removal of uric acid – Probenecid helps to more effectively get rid of uric acid in the kidneys thereby reducing your levels of blood uric acid that causes in the reduced chance of recurrence of an attack. A few people taking this medication could develop a rash, whereas a few others may suffer from stomach pains, and a negligible number might develop kidney stones.

2. Nutrition

Though it has not been proven if diets can lessen a person’s risk of developing gout, it is mainly on account of lack of studies, rather than the results of studies that have proven that diet is not effective. It would be sensible not to have a lot of food items that are high in purines, for instance sea food, meat organs and red meat. Limiting your alcohol intake could also be advantageous. Some people are advised to have low fat dairy products, whereas others may be required to consume whole-grain breads. Some also suggest drinking plenty of water as it could dilute the uric acid in your blood.