Gout : Causes, Symptoms, Diagnosis, Treatment

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In this blog, we learn about Gout disease. Gout is the term used to describe the symptoms that results from deposition of microcrystals of uric acid from hyperuricemic body fluids. 

uric acid
uric acid gout

This MSU crystals take months or years to grow to detectable size, implying long asymptomatic phase. So, gout disease not occur overnight. 

But, when it started it causes severe unbearable pain at any joint. Mostly, the joint at the bone of great toe is affected in 50% cases.

It occurs due to high level of uric acid in the blood. Increase level of uric acid in blood occurs due to diet, other health problem or genetic factors. We learn this topic in below format.

CAUSES

Uric acid is the waste product of purine metabolism. This waste product is excreted through urine & stool, this way it balance.

Normally, uric acid is available in blood around 2.5mg/dl. Here, dl means decilitre (100ml).

When, uric acid level increases more than 7mg/dl, it may causes problem like gout. 

  1. Uric acid disturbance Excretion problem
    90% gout occurs due to excretion problem. In which uric acid in blood is not excreted due to kidney problems or else.
    Overproduction
    10% gout occur due to overproduction of uric acid due to diet or genetic problem.
  2. Lifestyle
    Those who take high purine diet like alcohol, beverages, meat, sea food have chances of developing gout.
  3. Genetic
    It may be genetic, it runs in family.
  4. Risk factor
    Those who are suffering from hypertension, diabetes, cholesterol, obesity have more chances of developing gout compare to others.
  5. Medicines
    Taking medicines since long time like diuretics, B blocker, ace inhibitor may increases the chances of gout disease.

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SYMPTOMS

The prevalence of gout varies between populations but is approximately 1-2%. It mostly affect male (>5:1) ratio.

Acute gout

Mostly, first attack of gout affect the first MTP joint (above great toe) in over 50% of cases. 

Acute gout
Acute gout

Other common sites are in order of decreasing frequency, the ankle, midfoot, knee, small joints of hand, wrist and elbow.

Sudden pain
Pain of gout occurs suddenly. Withing 2-6 hours it reaches to the maximum severity. Everything is okay when patient slept, but often pain starts in early morning.

Tenderness
Severe pain describe as worst pain ever. Extreme tenderness, that patient can not wear socks or to let bedding rest on the joint. There is marked swelling of the joint. Joint is red shiny, inflamed.

Self limiting 
Acute gout is self limiting, which relieve within 5-14 days.

Chronic gout

After an acute gout attack, some people never have a same problem in future. But, few people have problems within a months or years. If repeated attack occurs, its called chronic gout. Chronic gout leads to joint erosion & joint destruction causing severe pain.

The MSU crystals will deposit in joint, forming tophi. Tophi may occur to extensor surface of fingers, hands, forearm, elbows, Achilles tendons & sometimes the helix of the ear.

Chronic gout
Chronic gout

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DIAGNOSIS

  1. Sign & symptoms
    We can do dignosis on basis of sign & symptoms. Sudden severe pain or repeated attack or presence of tophi indicate gout disease.
  2. Genetic
    If family member having gout problem, than patient may having this problem.
  3. Blood report
    Increase uric acid level in blood give supportive clue for gout.
  4. Confirm diagnosis
    Aspirated fluid from joint content MSU crystals gives confirmed diagnosis.

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Treatment & Management

  1. Avoid alcohol, beverages, meat, sea food. As these foods content purine, which increases the uric acid level by purine metabolism.
  2. Painkiller like ibrufen, naproxen, aspirin will give immediately relief from pain. Putting ice packs over affected joint will also give relief.
  3. Local steroid injection
    Prednisolone local injection at affected joint will give immediately relief.
  4. Colchicine medicine prevent & reduce joint inflammation.
  5. Allopurinol tablet in chronic gout. If patient having repeated problem of gout than allopurinol medicine is drug of choice. It lower the serum uric acid level.We must keep in mind that allopurinol or uricosuric drug should not give in acute attack of gout, because it may prolong the acute attack or trigger further episodes.
  6. Weight reduce will also helpful in symptomatic relief. Exercise & yoga will also helpful.
  7. Homeopathic medicine is also useful in gout disease.

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