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Definition of Gout

Gout is a complex form of arthritis characterised by sudden and severe attacks of pain, soreness and tenderness in the joints especially at the base of the big toe. It can affect anyone irrespective of gender and age - men are more prone to gout but women are also equally prone after menopause.

Symptoms of Gout

A bout of gout can happen very suddenly and without any warning, in the middle of the night with a sensation as if the big toe is on fire. The joint pain is such that it feels hot, swollen and tender that even the lightest weight feels unbearable. The symptoms are -

  • Excruciating and severe joint pain for the first 12 hours which mostly affects the large joint of the big toe, feet, ankles, knees, hands and wrists.
  • A lingering joint discomfort which can last for a few days or weeks after the severe pain subsides. Future attacks usually last longer and affect more joints.
  • The affected joints usually become inflamed, tender, hot, sore and red.
  • Joint mobility is hugely decreased with growing intensity of pain and damage of joints.
  • Tophus is a term used to describe a deposit of crystalline uric acid and other substances at the surface of joints or in skin or cartilage, typically a feature of gout.

Risks of Gout

High levels of uric acid in the body cause gout and the factors that increase uric acid are the following

  • A diet high on meat, seafood, sweetened beverages, fructose or fruit sugar and alcohol
  • An overweight or obese body which tends to produce more uric acid thus putting pressure on the kidneys to eliminate uric acid
  • Certain medical conditions like high blood pressure, chronic diseases like diabetes, metabolic syndrome, kidney and heart diseases
  • Use of certain drugs like thiazide diuretics to treat hypertension, low doses of aspirin and anti-rejection drugs in case of organ transplant patients
  • Family history of gout
  • Recent surgery or trauma

Diagnosis of Gout

The following tests help diagnose gout

  • Joint fluid test where a sample of fluid is taken from the affected joint to reveal presence of urate crystals
  • Blood test to measure uric acid and creatinine levels which can be misleading sometimes because not all with high uric acid levels have gout and some with normal uric acid levels have gout.
  • X-ray imaging of the joints to rule out other causes of joint problems
  • Musculoskeletal ultrasound, a technique quite popular in Europe and the US to detect urate crystals in an affected joint or a tophus
  • Dual energy CT scan is expensive and not widely used, sparingly to detect urate crystals in an affected joint even when not sore and red

Treatment of Gout

Gout is totally treatable with medications that the doctor will choose depending on the current state of health and patient preferences to reduce the risk of recurrence and complications like the development of tophi from urate crystal deposits -

  • Both over-the-counter and prescriptions Non-steroidal anti-inflammatory drugs (NSAIDs) to stop acute attacks and prevent future attacks. However, these medicines carry the risks of stomach pain, bleeding and ulcers
  • Pain relievers like colchicine to reduce gout pain though there may be side effects of nausea, vomiting and diarrhoea
  • Corticosteroids are reserved for patients who cannot take NSAIDs or pain relievers and is given in pill or injectable form to control gout related inflammation and pain. Possible side effects are mood changes, increased sugar levels and high BP.
  • Medications to block and limit uric acid production in the body may create side effects like rashes, low blood count, nausea and reduced liver function.
  • Medications to aid and improve the kidneys' ability in uric acid removal.
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