GOUT
What is gout?
Gout is an inflammatory arthritis that occurs when uric acid crystals accumulate within joints. It affects 1-2% of adults in developed countries and is the most common type of inflammatory arthritis worldwide.
A number of factors contribute to the onset of gout: notably nutrition, medication and genetics. Dietary contributors include alcohol (beer in particular), shellfish, red meat and sweet juices. Gout and hyperuricemia are associated with hypertension, diabetes mellitus, metabolic syndrome and renal and cardiovascular diseases
Dehydration may precipitate an acute attack of gout.
What are the symptoms?
There are four stage of gout: asymptomatic hyperuricemia; acute gout; interval gout; and chronic tophaceous gout.
Asymptomatic hyperuricemia is characterised by an excess amount of uric acid in the blood. During this stage of gout, there are usually no other symptoms. During the acute gout stage, uric acid crystals begin to develop in the joints, causing pain and swelling. The pain usually comes in intense episodes, subsiding after one to ten days, even without treatment. At this point it is best to seek medical treatment so that your uric acid levels can be monitored.
Interval gout, also known as intercritical gout, refers to the stage between gout flare-ups. During this time, there are no symptoms and joints function normally. It is important to note, however, that uric acid crystals continue to accumulate during this time.
Chronic tophaceous gout occurs when gout is left untreated. At this point, the condition can develop into chronic arthritis and lead to deformities and serious damage to the bones and cartilage.
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How is it diagnosed?
Your diagnosis will be confirmed after a thorough physical examination, as well as a review of your symptoms, such as the intensity of your joint pain and the severity of your inflammation.
Blood tests for uric acid levels, kidney functions and other relevant tests will be needed. It may be necessary to perform a test to check for a build-up of uric acid in your joint. A sample of joint fluid will be taken for testing. In some cases, an x-ray of the joint may also be taken to confirm the diagnosis of gout.
How can it be treated?
The key principles of gout management include establishing a definitive diagnosis, treating acute attacks promptly and using urate lowering therapies appropriately to dissolve uric acid crystals, prevent further attacks and joint damage. When serum urate levels are lowered below the saturation point, new crystal formation is prevented, existing crystals dissolve and gout can be cured.
Lifestyle changes, such as adjustments to your diet, reduced intake of alcohol, increased intake of water, and weight loss are important. In cases of tophaceous or recurrent gout, diet alone is very unlikely to control the disease.
While the acute attack of gout can be effectively treated with Colchicine, anti-inflammatory medications and prednisone, it is essential to address the underlying cause of the gout attacks which is the high uric acid level.
Puricos (Allopurinol) is the mainstay of treatment. Puricos reduces the production of uric acid and hence reduces the level of uric acid in the body. Puricos must however be started gradually to prevent gout acute attacks. Once Puricos is introduced, it is essential to take it regularly, even during flares to prevent fluctuations in uric acid levels and hence more acute attacks.
Blood tests can confirm that the dose of Puricos is correct by measuring serum uric acid levels. Once the uric acid levels are within the normal range for at least three months, a reduction in the frequency and severity of gouty episodes should be noted.
If used correctly however, gout medication is effective in preventing acute attacks as well as joint and kidney damage and gout should be a fully treatable condition.
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