Gout and Hyperuricemia-Causes, Sign, Symptoms and Treatment
Gout is condition that results from crystals of uric acid depositing in tissues of the body. Gout is characterized by an overload of uric acid in the body and recurring attacks of joint inflammation (arthritis). Chronic gout can lead to deposits of hard lumps of uric acid in and around the joints, decreased kidney function, and kidney stones.
Acute gouty arthritis is an attack of a metabolic disease marked by uric acid deposits in the joints. The disorder causes painful arthritis, especially in the joints of the feet and legs.
Normally, a small amount of uric acid is present in the blood as a result of cell breakdown. People with gout, however, have abnormally high levels of blood uric acid, usually because their kidneys cannot sufficiently remove enough uric acid through the urine. Or, the body may produce excess uric acid because of a hereditary condition or disease. In addition, consumption of certain foods that are metabolized to uric acid can bring about episodes of acute gouty arthritis. Excess uric acid in the blood causes monosodium urate crystals to form; the most common areas affected by gout are the joints of the foot, ankle, knee, wrist, and elbow. These deposits cause painful joint inflammation (arthritis).
Causes, incidence, and risk factors:
Gout is caused by an overproduction of uric acid or a reduced ability of the kidney to get rid of uric acid. The exact cause is unknown. It is more common in males, postmenopausal women, and people who drink alcohol.
Gout is caused by too much uric acid in the blood. Most of the time, having too much uric acid is not harmful. Many people with high levels in their blood never get gout. But when uric acid levels in the blood are too high, the uric acid may form hard crystals in your joints.
Your chances of getting gout are higher if you are overweight, drink too much alcohol, or eat too much meat and fish that are high in chemicals called purines.
Signs and Symptoms
The symptoms of gout are that the big toe joint is most frequently affected, but instep, ankle, knee wrist and elbow are common sites, sometimes even the spine; bouts may vary from days apart to several attacks a year; first attacks may be in only one joint, lasting for days; later attacks may affect more joints; there may be joint deformation if unattended; limitation of joint movement is precipitated by stress, or wrong diet; sharp, needle-like pain on movement of joints; skin is tense, hot, shiny and dusky red or purplish; systemic reactions may include fever, heart rate increase, and chills and malaise.
Treatment
A prescription medicine called colchicine helps reduce pain, swelling, and inflammation associated with acute gout attacks. The medication decreases the inflammation caused by uric acid crystals within the joint. It does not decrease the uric acid levels in the bloodstream.
Nonsteroidal anti-inflammatory drugs (NSAIDs). High doses of NSAIDs such as indomethacin or ibuprofen are the most common treatment for acute gouty arthritis. However, aspirin should not be used for this condition because it can elevate levels of uric acid in the blood. Patients who have a history of ulcers or kidney problems, or those taking anticoagulant medication, may be treated with another type of anti-inflammatory medication, or other medications may be used in conjunction with NSAIDs to protect against unwanted side effects.
Acute gout is treated with drugs that block the inflammatory reaction. One of the oldest agents known to be effective against acute gout is colchicine, which comes from a common European plant, the autumn crocus, and is marketed in this country primarily as a generic drug. An English clergyman, Sidney Smith, said a century and a half ago that he had only to go into his garden and hold out his gouty toe to the plant to obtain a prompt cure. This may have been an exaggeration, but a rapid response to colchicine suggests that the patient does indeed have gout.
