Gout is a form of arthritis that causes sudden, severe attacks of pain, tenderness, redness, warmth, and swelling (inflammation) in some joints. It often affects one joint at a time, but may affect a few or even many. The large toe is most often affected, but gout can also affect other joints in the leg (knee, ankle, foot) and less often in the arms (hand, wrist, and elbow). The spine is rarely affected.
The symptoms are sudden, intense joint pain, which often first occurs in the early morning hours. Swollen, tender joint that’s warm to the touch, red or purple skin around the joint. Gout can be caused although diet and excessive drinking of alcohol can contribute to the development of gout, they are not the main cause of the disorder. Gout results from abnormal deposits of sodium urate crystals around the joint cartilage and their later release into the joint fluid.
Gout attacks can recur from time to time in the same or different joints. The initial attack may last several days to two weeks unless it is treated. Over time, gout attacks may occur more often, involve more joints, have more severe symptoms, and last longer. Repeated attacks can damage the joint. Lumpy collections of uric acid called tophi can develop near joints, in the skin, or within bones. Some people will only have a single attack. However, about 90 percent of patients who have one gout attack will have at least a second attack, although it may not occur for several years after the initial attack.
Gout is mainly affected to men (usually over age 40) and women after menopause, people who are overweight, people who frequently drink alcohol. When gout affects women, it is usually after menopause, especially in women who are taking certain medicines. Younger patients may be affected by gout if they have been taking certain medicines for long periods of time, frequently drink alcoholic beverages, or have certain genetic disorders.
Gout cannot be diagnosed simply from a blood test, since many people have elevated blood uric acid levels, but never develop gout. Rather, gout is diagnosed from the fluid withdrawn from an inflamed joint. The fluid is observed under a microscope for sodium urate crystals. Fluid is removed through a needle from the inflamed joint during a procedure called arthrocentesis. Removing the fluid may reduce pressure within the joint and thereby reduce pain. A lack of crystals does not necessarily rule out a diagnosis of gout. Occasionally, crystals may not be observed the first time, but may be seen if additional fluid is removed at another time during a subsequent attack. Since gout can cause chronic joint pain and involve other joints, it is extremely important that an accurate diagnosis be made. Then, your doctor can prescribe the appropriate specific treatment.
There is no cure for gout, but it can be treated and controlled. Attacks can be prevented with appropriate therapy to lower the blood uric acid level. The main goals of treatment are to relieve pain and inflammation. Prevent future gout attacks could lead to permanent joint damage. The type of treatment prescribed will depend on several factors, including the person’s age, type of medicines he or she is taking, overall health, medical history, and severity of gout attacks. Gout is mainly treated with medicine.
Gout can be treated through dietary changes for most people do not play a major role in controlling their uric acid levels. However, limiting certain foods, such as fructose containing corn syrup, red meat, beer that cause an increased production of uric acid and reducing alcohol intake are often helpful. Certain foods likes cherries, low fat diary products can decrease uric acid levels.
Dr. Gaurav Seth
Dept of Rheumatology