Gout (Uric Acid Crystals in the Joint)

Definition

Gout is a type of arthritis characterized by sudden or long standing episodes of pain, swelling, redness and heat around one or more joints. The big toe is the most commonly affected joint. Deposition of urate crystals, due to raised level of uric acid in the blood, is the reason behind attacks of gout. Men and women after menopause are more at risk of suffering from gout. Treatment options include drug therapy along with lifestyle changes. Gout attacks can be prevented to a large degree but patients at risk need to be very disciplined with regards to the dietary and lifestyle changes.

Symptoms

Gout usually presents as :

  • Sudden onset of excruciating pain which is so intense that even contact with a bed sheet makes it unbearable. The pain is usually at night along with swelling, redness commonly around the big toe. Other joints namely wrist, finger, knee even heel may also be affected.
  • Repeated episodes of gout attack may occur several times a year leading to restricted movement of the affected joints due to joint damage.
  • In untreated long standing cases of gout, hard deposits of urate crystals are found beneath the skin around fingers, hand, elbow, Achilles tendon. These deposits (“tophi”) are usually painless but may become painful during an acute attack of gout.
  • Sometimes urate crystals may also deposit in the kidney (renal stones) hampering normal functioning of kidney.

Causes

Increased level of blood uric acid due to reduced excretion by the kidneys or increased production is the main reason behind gout. Symptoms of gout occur due to precipitation of urate (monosodium) crystals around the joints, beneath the skin and in the kidney. This crystallization of uric acid occurs under influence of certain precipitating factors, namely :

  • Cool temperature which is the reason why joints of the feet are more commonly affected at night.
  • Rapid fluctuation of blood uric acid level due to trauma, surgery and certain drugs (water pills).
  • Acidosis which is increased acidity of the blood.

The urate crystal deposits trigger inflammatory changes around the affected area (symtoms) via improper activation of the immune system.

Risk factors

The various risk factors are :

  • Diet: consumption of vegetables rich in purine (beans, peas, spinach, lentils, mushrooms), protein (meat), sea food.
  • Alcoholism: more than 2 drinks/day in males and more than 1 drink/day in females.
  • Lack of physical fitness.
  • Genetic defects: certain genetic disorders may lead to inherited high level of uric acid (hyperuricemia).
  • Certain medical condition may raise the level of blood uric acid secondarily like obesity, insulin resistance, high blood pressure, raised cholesterol, triglyceride levels, lead poisoning (compromising kidney function) and renal failure due to other medical causes like skin diseases such as psoriasis and organ transplant.
  • Certain drug intake: diuretics (water pills), aspirin (pain killer), niacin, immunity lowering drugs (immunosuppressive) like ciclosporin and tacrolimus.
  • Men are more commonly affected except postmenopausal women.

Treatment

Choice of drug depends on the nature of gouty attack, acute or chronic.

Acute gout

  • Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen etc to reduce pain and inflammation.
  • Colchicine to relief gouty pain.
  • Steroids to control inflammation

Chronic gout

After relief of acute pain of gout, the following drugs are used to prevent relapse of acute attack.

  • Allopurinol inhibits production of uric acid.
  • Probenecid facilitates removal of uric acid via kidney.

More Related Topics


Related pages


gym itchcauses of swollen neck lymph nodesitching varginaitchy breasts pmsarthritis in clavicleitchy painful skin without rashenlarged vulvawhat causes scalp pimplesscaly skin under breastfoul smelling belchingsore breasts all the timeitching in viginasymptoms of e coli includebrown bleeding in first trimesterfloating stoolsback pain under left rib cagediscomfort under rib cageodynophagia symptomsinflamed hair follicledark brown spotting during early pregnancysputum colour and diagnosistrichomonas and trichomoniasisswollen perineal areatinea pedis transmissiondermatophytes picturesupper left abdominal discomfort after eatingdischarge from bowelwhat organ of digestion is located in the epigastric regionnatural herbs for breast enlargementcauses of itchy throat and coughleft sided rib pain causessmelling vaginasbreast enlargment creamcan a woman lactate without giving birthmenses crampstool thicknessswollen lymph glands in neck treatmentcoughing up solid white mucusswelling on left side of neck above collarbonebrown discharge after 2 weeks of periodwhat causes blood clots during my periodleft arm swellingitchy discharge before periodeczema under breastsirritated skin under breastwatery clear diarrheagreen diarrhea and stomach painwhite thick discharge early pregnancythroat mucus colorright upper quad pain radiating to backpostpartum vaginal bleedingsmelly rash under breastear blister treatmentbad odor in vaginasulphur breathsupplement for breast growthhand dermatitis treatmentwhat are the signs of syphilis in a womancause of frothy urinebump at roof of mouthstitch pain on right side of abdomenvaginal monosubluxation treatmentwhat causes urinary tract infection in pregnancyorgan in lower left abdomenis folliculitis itchythings to soften stoolbrushing teeth techniquediscolored vaginal dischargehow to loosen bowels