Arthritis Focus: Gout
By: Sara M. Aksoy
One of the more
common forms of arthritis, gout affects about one percent of the population. It
is a systemic disease, meaning that it affects all the joints of the body,
rather than a localized disease, meaning that the symptoms are contained to one
area. The joint inflammation and pain associated with gout is the result of
uric acid crystals being deposited in the joint.
Causes
Uric acid is a product of the human body after breaking down a
naturally occurring chemical called purines, which are found in certain foods
and drinks. When the body is unable to get rid of, or makes too much uric acid,
high levels of this acid accumulate in the body. This is a condition known as
hyperuricaemia.
At high concentrations, uric acid may form crystals in the joint,
resulting in an inflammatory response that triggers the swelling and pain that
are characteristic of gout.
Demographics
Gout is found most commonly in men, and is very rarely seen in women
until after menopause. The onset of gout in men occurs more frequently at
younger ages.
While there is no one cause that is implicated in causing gout, gout
may develop in people who already have or are predisposed to have high levels
of uric acid in the body. Factors affecting this include a family history,
obesity, high alcohol intake, and use of certain blood pressure medications.
Symptoms
Gout is characterized by short acute attacks of arthritis pain
separated by fairly asymptomatic periods where there are no symptoms. These
attacks usually involve 1 to 2 joints at a time, often affecting joints of the
feet and ankles. Without treatment, symptoms of a gouty attack usually subside
in about one week.
The first sign of gout is often an acute attack that results in severe
pain and swelling in the joint within 12 to 24 hours. If the swelling becomes
significant, there may be red, shiny skin covering the joint.
Over time, attacks tend to be more frequent and severe, with many
joints becoming involved. Long-term
effects of gout may also include the development of chronic joint disease where
the joint inflammation does not subside and joint damage is continuous.
Symptoms of gout may also include certain complications when uric acid
levels are continuously high or when acute attacks are frequent and severe.
These include whitish deposits that form nodules called tophi that may appear on the joint or
ears.
Treatment
Treatment of gout involves two goals: decreasing factors that affect
the high uric acid levels and treating the pain of acute attacks.
Correcting for high uric acid levels using conservative methods includes
avoiding foods that contain high levels of purines such as red meat, shellfish,
peas, lentils and beans. Alcohol intake
should be reduced and weight lost as needed. The health care provider will
change any medication implicated in raising uric acid levels, if necessary.
If conservative methods are not effective at decreasing uric acid
levels in the body, medication is available to actively do so. These
medications may work by helping the kidneys eliminate excess uric acid or by
blocking uric acid production in the body. During the first few months of
treatment with these medications, attacks may be more frequent and more severe.
Treatment of the acute gouty crises usually involves the use of
non-steroidal anti-inflammatory drugs (NSAIDs), which reduce the inflammation
and pain of the attack. When taken soon after the first sign of attack, NSAIDs
can control pain within 12 to 24 hours. In addition, fluid intake should be
increased by 4 to 5 glasses of water during a gouty attack to help the body clear
the excess uric acid out.