GOUT
What is Gout?
Gout is a painful condition similar to arthritis involving the joints as the body is subjected to an imbalance of Uric Acid build up. The joints are the most commonly affected part of the body, especially the big toes and knee’s. When the big toes are involved it is known as “Podagra”. Uric Acid can also be deposited in the kidneys and urinary tract causing “Kidney Stones”, if left untreated this can also lead to “Kidney Damage”.
Progressive gout can cause bone deterioration and deformity of the extremities. When someone has many attacks over years, Tophaceous gout can develop. “Tophaceous Gout” means that a large amounts of Uric Acid crystals have accumulated into masses called “Tophi” aka “Toe-fi”. Tophi are visible and/or can be felt in the soft tissues over joints “Looking like large Cysts or Blisters on the joints”, this is especially common on fingers, hands, elbows, feet, and Achilles tendons. They can even have a white or yellow substance inside which could be drained when inflamed by medical professionals.
What causes Gout?
Gout is caused by a defect or damage to your renal system or commonly known as your Urinary System “Two Kidneys, Two Ureters, a Urethra and a Bladder”, this damage causes an abundance of “uric acid” to be formed. When we eat foods high in purines, the body breaks down the purines by creating uric acid, an over abundance of uric acid then can cause a painful condition involving the joints similar to arthritis as the body then accumulates uric acid unable to excrete it fast enough through normal bladder channels. About a third of those who produce high levels of Uric Acid will develop Gout, however it is not known why some people develop symptoms and others do not. Once the Uric Acid is in the blood stream it can form sharp, needle like crystals that are deposited in the joints, tendons, and surrounding tissues.
Risk Factors also include:
Etiology “the cause, set of causes, or manner of causation”
Obesity
High Blood Pressure
Pathobiology “The branch of biology that deals with pathology”
Injury or recent surgery
Fasting or Overeating “Irregular eating habits”
Consuming excessive amounts of Alcohol on a regular basis.
Diets high in meat, shellfish, and beverages sweetened with high-fructose corn syrup
Taking medications that increase blood levels of uric acid “Diuretics”
Pathology “the science of the causes and effects of diseases”
Renal Defect “Defects to your Kidneys, Uriters, Bladder or Urethra”
Diagnosis
Gout can be diagnosed by confirming and identification of monosodium urate crystals in synovial fluid of the affected joint or tissue. The Fluid is drawn from the affected joint to look for the uric acid crystals and often clinicians will treat the gout when there are both classic symptoms and high levels of uric acid in the blood. X-rays of the affected joint may also show calcium-containing crystal deposits in the cartilage and further options may be discussed with your physician on treatment.
Symptoms of GOUT
Symptoms of “Acute Gout” are sudden, severe joint pain with redness, swelling, and tenderness of the joint. The joint may feel quite warm to the touch and even throb.
Pain in your big toes
Pain in your knees, ankles, wrists and or elbows
Intense pain that strikes in the middle of the night “Knees and lower extremeties are often the first to strike”
Pain that occurs in flares: rapidly worsens, then starts to ease up in the joints.
Strange lumps and bumps around your joints
Kidney Stones
Distortion of joints along fingers and toes “Tophi Gout”
Complications
Rapidly progressing “Osteoarthritis” can occur due to wearing down joint cartilage, bone cysts or spurs, and even fractures may occur with prolonged gout flairs.
Pseudo gout – Like Gout, pseudo gout is a form of arthritis that cuases dudden joint pain and swelling. The “Pseudo” part means that it looks like something else. The term Pseudo Gout is used because this is very similar to gout, while gout is caused by “uric acid crystals” pseudo gout is caused by “calcium pyrophosphate dehydrate crystals CPPD. Though the two have similar symptoms, treatment is somewhat different.
Pseudo gout causes sudden attacks of joint pain, swelling, and warmth of the flesh in the affected area and even fever. The attacks can last for days to weeks. The knee is the most commonly affected but it can also affect the ankles, feet, shoulders, elbows, wrists or hands “any joint”. CPPD crystals can also be deposited in the joint cartilage and never cause symptoms.
Treatments of Gout
There is “no” treatment that can “completely” remove or prevent the formation of calcium pyrophosphate dehydrate crystals CPPD “The pain causing calcium crystals in the joints” caused by Pseudo-Gout . Treatments for Gout and Pseud-Gout are generally aimed at reducing pain, swelling and the cause.
– Medications –
Acute Gout – May be treated with non-steroidal anti-inflammatory drugs NSAIDS, cortico-steroids
– Colchicine – Often used by people who cannot tolerate NSAIDS. Colchicine can have significant side effects based on the dose used. These side effects include nausea, vomiting, diarrhea and abdominal pain.
-Steroids “Prednisone” – Used in people who cannot take NSAIDS’s or Colchicine. Prednisone is associated with an increased risk of a recurrent gout attack.
-Other Medications like “Politicise “Krystexxa”, Probenecid, Xanthine oxidase inhibitors or Haloperidol “Zyloprim” or febuxostat “uloric” may be prescribed by your physician. Please consult your doctor for more information.
– Serum urate-lowering therapy “Talk to your physician about this option”
Prophylactic Therapy – “Medicine or course of action used to prevent disease”
Prophylactic Therapy is used to prevent or reduce the number of acute Gout attacks. It is used when someone has repeated gout attacks, or has already had joint damage or developed tophi.
Long-Term treatment is aimed at lowering the level of uric acid in the blood so that crystals do not form. Colchicine is often used at low doses for a period of time while drugs that lower uric acid levels are started. “Allopurinol” is one of the most commonly used long term drugs. Allopurinol prevents the formation of uric acid, however it can have side effects including “rash, low white blood cell counts, diarrhea and fever”.
For more information please consult your local physician for options that will suite you body’s needs.
Lifestyle
Obesity is a strong risk factor for developing gout or having an acute gout attack. This risk is especially high in those with known cardiovascular disease CVD.
Dietary changes can reduce the frequency of attacks
Reduce
– Avoiding “Red Meat”, including wild game
– Avoiding particular seafood especially “shellfish and large salt water fish”
– Decrease intake of “Saturated Fats”
– Reduce Alcohol Consumption – Alcohol especially “Beer” interferes with the body’s natural ability to eliminate uric acid from the body.
– Avoiding foods and beverages containing “high-fructose corn syrup”
– Joint immobilization – Patients may be advised to avoid weight bearing “walking or running” if the legs or feet are involved and to limit activity for a period of time to minimize pain and swelling. A splint may be used temporarily to limit movement.
Increase
– Increased dietary protein from “low-fat” dairy products
– Increase intake of “whole grains, brown rice, oats or beans
– Coffee Moderate use “may decrease blood uric acid levels”
– Vitamin C 500mg daily has a mild effect on lowering uric acid levels
– Cherries, blueberries, purple grapes, and raspberries have also been found to be beneficial at lowering uric acid levels and promoting a healthy renal system.
– Weight loss significantly reduces the risk of Gout
Support for Gout
For more information please consult your local physician or visit your local online medical group dedicated to Gout.
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If your symptoms get worse at any time or you notice new symptoms from the list above, call your doctor or Health Link “811 in Alberta”. You can also call the “Health Link Alberta 24/7 if you have questions about C.Diff or any of the information in this handout.
“This material is for information purposes only. It should not be used in place of medical advice, instruction, and/or treatment. If you have questions, speak to your doctor or appropriate healthcare provider.”
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