Causes, incidence, and risk factors of Gout
Gout is caused by a defect in metabolism that results in an overproduction of uric acid, or a reduced ability of the kidney to eliminate uric acid. The exact cause of the metabolic defect is unknown. The condition may also develop in people with diabetes mellitus, obesity, sickle cell anemia, and kidney disease, or it may follow drug therapy that interferes with uric acid excretion.
Gout has four stages
Asymptomatic (without symptoms), acute, intercritical, and chronic. In acute gouty arthritis, symptoms develop suddenly and usually involve only one or a few joints. The pain frequently starts during the night and is often described as throbbing, crushing, or excruciating. The joint appears infected with signs of warmth, redness, and tenderness. The attacks of painful joints may subside in several days, but may recur at irregular intervals. Subsequent attacks usually have a longer duration. Some people may progress to chronic gouty arthritis, while others may have no further attacks. Risk is increased in males, postmenopausal women, and people with kidney disease, diabetes mellitus, sickle cell anemia, or obesity. The incidence is 5 out of 1000 people.
Prevention of Gout
The disorder itself may not be preventable, although some precipitating factors may include trauma, alcohol consumption, and dietary purines. Medications may reduce attacks in a person with gout.
Symptoms of Gout
The following symptoms are often noticed when a person is affected by Gout:
- Joint pain begins suddenly in one or more joints (hip pain, knee pain, ankle pain, foot pain, shoulder pain, elbow pain, wrist pain, hand pain, or pain in other joints).
- The great toe, knee, or ankle joint are most often affected.
- Joint swelling of any of the above joints, stiffness of the joint.
- The joint may be warm and red fever may be present.
- Skin lump over a joint.
- Chalky material draining out of the lump.
- Finger pad abnormalities.
- Physical examination is performed to determine the acuteness of arthritis.
- Synovial fluid analysis shows uric acid crystals.
- One of the common signs is elevation of Uric acid (blood test) above 7.5 mg/dl.
- Joint X–rays are also performed.
- Uric acid.
- Urine synovial biopsy.
- Blood differential.
The objectives of treatment are mainly to stop the pain and inflammation associated with the initial attack, and to prevent future attacks.
Colchicine is one of the anti–inflammatory medications that is effective in reducing the pain, swelling, and inflammation associated with acute gout attacks. The pain usually subsides within 12 hours of starting treatment and is completely relieved in 48 hours. The medication works by decreasing the inflammation caused by uric acid crystals within the joint. However, it does not decrease the uric acid levels in the bloodstream. Daily use of colchicine or allopurinol helps prevent future attacks. Codeine or other analgesics may occasionally be prescribed for pain relief. Increased fluid intake prevents the formation of kidney stones. Sometimes, a diet low in purines is prescribed. Organ meats, beer, wine and certain types of fish contain high levels of purines.
Complications with Gout
Gout can lead to following complications:
- Side effects of medications.
- Chronic gouty arthritis.
- kidney stones.
- kidney dysfunction.