HEALTH TALK: Gout

INTRODUCTION

If you’ve ever awakened in the middle of the night and your big toe feels like it’s on fire, it’s hot, swollen and so tender that even the weight of a blanket on it seems intolerable, you could have suffered an acute attack of gout – or gouty arthritis. This is a form of arthritis that’s characterized by sudden severe attacks of pain, redness and tenderness in joints.

Gout is complex and can affect anyone. Men are more likely to get it than women are, but women become increasingly susceptible to gout after menopause.

Of course, gout is treatable, and there are ways to keep it from recurring.

SIGNS AND SYMPTOMS

These are almost always acute, occurring suddenly – often at night – and without warning. They include:

•    Intense joint pain. Gout usually affects the large joint of your big toe (metatarso-phalangeal joint) but can occur in your feet, ankles, knees, hands, and wrists. The pain typically lasts five to ten days, and then stops. The discomfort subsides gradually over one to two weeks, leaving the joint apparently normal and pain-free.

•    Inflammation and redness. The affected joint or joints become swollen, tender, and red.

WHAT ARE THE CAUSES?

The cause of gout is an inflammation in your joint as a result of accumulation of urate crystals. Uric acid is a waste product formed from the breakdown of purines. These are substances found naturally in your body, as well as in certain foods, in particular organ meats, such as liver, brains, kidney, and sweetbreads, and anchovies, herring, asparagus and mushrooms.

Normally, uric acid dissolves in your blood and passes through your kidney into your urine. But sometimes, your body either produces too much or excretes too little of this acid. In that case, uric acid can build up, forming sharp, needle-like crystals (urate) in a joint or surrounding tissue that cause pain, inflammation and swelling. By the way, in an acidic urine, you may find a lot of uric acid crystals, whereas in an alkaline urine, you may find few. This is normal.

Crystal deposits also cause another condition, known as false gout (pseudogout). Rather than being composed of uric acid, pseudogout crystals are made of calcium pyrophosphate dihydrate. And while pseudogout can affect the big toe, it’s more likely to attack large joints such as your knees, wrists and ankles.

RISK FACTORS

The following conditions or circumstances can increase the chances you’ll develop high levels of uric acid that may lead to gout:

•    Lifestyle factors. Excessive consumption of alcohol is a common lifestyle factor that increases the risk of gout. Excess alcohol generally means more than two drinks a day for men and more than one for women. Gaining 30 pounds or more than your ideal weight during adulthood also increases your risk.

•    Medical conditions. Untreated high blood pressure (hypertension) and chronic conditions, such as diabetes, high levels of fat and cholesterol in the blood, and narrowing of the arteries (arteriosclerosis), make it more likely that you’ll develop gout.

•    Certain medications. The use of thiazide diuretics – used to treat hypertension – and low-dose aspirin can also increase uric acid levels. This is not so much a problem anymore (for thiazides), because we’re using lower doses than previously, which are just as effective for treating hypertension.

•    Genetics. 20% or one in five people with gout have had a family history of the condition.

•    Age and sex. Men are more often affected than women, mostly because women tend to have lower uric acid levels than men do. After menopause, however, women’s uric acid levels approach those of men. Men usually develop gout earlier too – between the ages of 40 to 50 – whereas women generally develop symptoms after menopause, as stated.

WHEN TO CHECK DOC

If you experience sudden, intense pain in a joint, call the doc. Untreated gout can lead to worsening pain and joint damage.

Seek medical care immediately if you have a fever and a joint is hot and inflamed, which can also be a sign of infection.

SCREENING AND DIAGNOSIS

To help diagnose gout, your doctor may withdraw fluid from the affected joint to check for uric acid crystals in your white blood cells. Other tests may include:

•    Urine test. This is to measure the amounts of uric acid you’re excreting.
•    Blood test. You may need to have a test done to measure the uric acid level in your blood.

ANY COMPLICATIONS?

Yes. Some people with gout develop a chronic form of arthritis, often with discolored deposits under the skin called tophi (singular: tophus). These may occur on your earlobes or at the back of your elbow (tophaceous gout). A small number of people with gout also develop kidney stones.

TREATMENT

For gout attacks, NSAID’s or non-steroidal anti-inflammatory drugs such as Ibuprofen (Advil) and Naproxen (Aleve) may provide relief. A drug called Colchicine may also be used in the acute phase, but its dosage has to be adjusted carefully while you are concurrently on the NSAID.

For severe cases, a corticosteroid drug such as prednisolone may be prescribed. Some doctors inject cortisone into the affected joint; side effects can occur, and injections are generally limited to no more than three a year. In fact, all the groups of drugs mentioned have side effects, and you should ask your doctor about them.

ANY PREVENTIVE MEASURES?

Well,there is no sure way to prevent initial or subsequent gout attacks, but if you already have gout, medications may be prescribed to reduce the risk or lessen the severity of future episodes. These include allopurinol and probenecid. When taken daily, they slow the rate at which uric acid is produced, and speed its elimination from your body. Generally, keeping uric acid levels within a normal range is the long term key to preventing gout.

HOW TO CARE FOR YOURSELF

•    Maintain a healthy weight. Gradual weight loss will lessen the load on affected weight-bearing joints. Losing weight may also decrease uric acid levels. Avoid fasting or rapid weight loss; uric acid levels may temporarily increase.

•    Avoid excessive amounts of animal protein. Remember, organ meats (liver, brains, kidney and sweet breads), anchovies, herring and mackerel are particularly high in purines.

•    Limit or avoid alcohol.  Too much alcohol can inhibit the excretion of uric acid, in turn leading to gout. If you’re a man, no more than two drinks a day for you. If you’re a woman, no more than one is allowed. If you’re having an attack, avoid that stuff completely.

•    Drink plenty of liquids. Fluids help dilute uric acid in your blood and urine, so drink enough water and fluids every day.

See you next week.