10 important things to know about gout

  1. What is gout? – Gout is a type of arthritis caused by deposition of uric acid. Uric acid is a by-product of the breaking down of proteins of the purine pathway. Purines are either made by the body, ingested as food proteins (e.g. meats) or removed from body tissues. Normally, uric acid is removed from the body majorly through the kidney and a lesser part through the intestines. Uric acid levels in blood increase with increased production or reduced removal through the kidney and the uric acid is then deposited in the body. Initially in the joints but can also be deposited in the soft tissues like under the skin or in organs like the kidney itself.
  2. Who gets gout? – Gout is predominantly a disease of men past puberty, more common among the affluent in society in the urban setup and in overweight individuals.
  3. The big toe – The big toe is the commonest sight of the first gouty arthritis attack (up to 70% of people) and presents with a hot, swollen, painful toe that makes it gout-big toeimpossible to wear closed shoes or walk normally. It is a classical sign and any practitioner seeing a patient presenting with the same without obvious trauma must suspect gouty arthritis. This is not to say that one cannot present with pain and swelling in any of the other small or large joints.
  4. Danger foods – Too much of anything is poison. The high levels of proteins that lead Gout n foodsto increases in uric acid comes from the everyday foods that we eat but done at excessive levels. These usually mean any meat cooked in whatever way.
  5. Alcohol worsens gout! – Fact or fiction? The relationship between alcohol and gout has been studied and discussed for centuries. This relationship has been determined using different studies and experiments and the beliefs include that;
    1. Alcohol especially beer contains purines which is the protein that is broken down to uric acid. This means that drinking beer is equivalent to eating proteins.
    2. Alcohol consumption leads to lactic acidosis which reduces the removal of uric acid by the kidneys and thus results in increased levels in blood which can then be deposited in the joints and/or tissues. This is one of the reasons that many people suffering a gouty attack suffer after a day of intense indulging in meat and alcohol.
  6. Diagnosis of gout– Although clinical acumen is essential in suspecting gout, a blood test to check the levels of uric acid is available. It is a simple, quick, relatively inexpensive test that can quickly show the levels of uric acid in your body. This forms a basis of diagnosis especially if it is the first time that a person is presenting with symptoms of gout.
  7. Blood pressure and gout – Many patients with gout have problems with High Blood Pressure. There are many reason why this may be so;
    1. Acute pain – releases adrenaline which increases your Blood Pressure.
    2. Destruction of the kidneys – The kidney is an important organ in regularizing of blood pressure.
    3. Incidentally found in association with lifestyle – Being overweight, having poor lipid control, little exercises, and excess alcohol consumption.
  8. Treatment of gout:
    1. Manage pain and inflammation – When a person presents with an attack of grout managementgout, the pain is usually quite severe. Management of pain is the most important first step. This is prescribed in such a way as to contain medications that reduce inflammation in order to try and limit the inflammation in the joint which can in the long run lead to deformity of the joints.
    2. Lower uric acid levels – Once the acute pain has receded in 1-3 days, then medications are commenced to lower the uric acid. Every patient must be warned of the risk of the pain returning or another joint getting affected because some of the medications work by pulling the uric acid from the tissues. This means that the uric acid levels will increase in the blood for a while and as the medications work to remove this excess through the kidneys, the same may end up where it was not intended.
    3. Drink a lot of water – As an attempt is made to pull the uric acid from the tissues into the blood so that the uric acid is removed through the kidney, one must also drink a lot of water in order to flash the kidneys and encourage elimination of the uric acid through the urine.
    4. Mobilization of joints – Long term and/or repeated attack of joint by gouty gout deformityarthritis can eventually lead to deformity of joints with reduced usage of the joint and limbs. Thus, once pain has reduced acutely, any person suffering an attack of gout should ensure that they are able to use the joints normally or else inform their health provider. It is however, very important to note that prevention of deformity is much easier than trying to correct them and the best way to prevent it, is to try and get rid of the risk factor that is making one prone to gouty attacks.
  9. Follow up
    1. Uric acid levels – Any person who has suffered an attack of gout or has risk factors making them susceptible to gout should do regular assays as advised by their healthcare provider in order to keep the levels within normal. But, it is important to note that with subsequent attacks, a person can get an attack of gout arthritis with normal levels of uric acid. The aim then becomes to note any gradual increase of uric acids and intervene as soon as possible. It is also important to note that there are people with increased levels of uric acid who have no symptoms at all.
    2. Kidney test – The kidney is the organ that removes uric acid from the body normally and hence an annual test is mandatory to ensure that it is functioning well. It will also determine types and quantities of medicines that a person will be treated with.
    3. Blood sugar assay – This should be done at least once to rule out any pre-existing un-diagnosed Diabetes. It can also be done once a year as regular annual examinations but more frequently if it is found to be abnormal.
    4. Lipid profile – This should be done at least once at the beginning of treatment and followed up annually as is needed.
    5. Blood Pressure – This should be done at least once a month for every person with an abnormal blood pressure reading once the pressure has been stabilized.
  10. Non-food causes of gout – Some people present with gout and yet are insistent that their diet does not contains excess meats or other proteins and that they do not consume alcohol. Thus, other causes of excess uric acid in the blood must be sort and may include the following;
    1. Malignancies – Malignancy whether benign or cancerous, result from an uncontrolled growth of tissues in the body. These overgrown tissues are also broken down by the body using its regular mechanisms to balance the body’s turnover of cells. If the body is breaking down more cells than usual, it means that there will be more proteins being broken down, hence more uric acid being produced and hence gout development becomes a risk. Example include blood and bone marrow conditions and psoriasis.
    2. Renal dysfunction of whatever cause – As mentioned earlier, uric acid in every person is removed through the kidneys. If a person’s kidneys are not working well, it can result in the uric acid not being removed from the body and in turn it will accumulate in the blood and eventually be deposited somewhere else. Causes of renal dysfunction are myriad and may include hypertension, diabetes, auto-immune diseases, injury and prescription drugs.
    3. Drugs – There are drugs that are used in the management of various ailments that may unfortunately also lead to gouty arthritis. This is usually due to reduction in the elimination of uric acid by the kidneys. Common drugs include; diuretics for treating hypertension and low dose aspirin.
    4. Lactic acidosis – Any situation that cause an increase in lactic acidosis predisposes to reduced removal of uric acid and gout. These commonly include alcohol as mentioned above as well as exercises, starvation and vomiting.
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