GET TO GRIPS WITH GOUT

Gout is an excruciatingly painful arthritic joint inflammation of sudden onset. It is caused by the formation and deposition of urate crystals in the affected joint. Purines are organic compounds that are not necessarily harmful. In fact, they are part of all human tissue and found in many foods. Purines produce uric acid and uric acid produces urate crystals. Uric acid has two chemical forms (tautomers) in which it exists. The one is stable and the other unstable. The unstable form can form urate crystals that are nearly insoluble in water and deposit themselves in the joints to cause gout.

SIGNS AND SYMPTOMS

A common form of arthritis, gout is characterised by recurrent attacks of extreme pain, swelling and redness. Unlike most other types of arthritis which develop slowly, an attack of gout occurs suddenly, quite literally overnight. Gout can present in different joints, but the first metatarsophalangeal joint (big toe) is most often affected. Called podagra, it accounts for 50% of all gout attacks. Other joints, such as the heels, knee, wrist and fingers may also be affected.

The following are characteristic of gout:

• Recurrent: It has a recurrent nature and will return again and again.

• Intense pain: The acute attack usually begins between 2am and 4am. This is due to the lower body temperature during the night.

• Inflammation has the following components: The affected joint is:

• Red in colour

• Swollen

• Hot

• Very sensitive to any touch

• Fatigue and fever

• Tophi: Long-standing increased uric acid levels may result in hard, painless deposits of uric acid crystals. These deposits are known as Tophi.

Some people have gout attacks every few months, while others are luckier and only suffer an attack every few years. Unfortunately, as time passes, attacks tend to become more frequent and affect more joints.

TREATMENT

Pain management is a crucial part of living with gout. The aim of gout treatment is to settle the symptoms of the acute attack quickly and safely. This treatment is usually short term and limited to the duration of the flare. An acute gout attack will generally reach its peak 12-24 hours after onset, and then will slowly begin to resolve even without treatment. Full recovery from a gout attack (without treatment) takes approximately 7-14 days.

A common form of arthritis, gout is characterised by recurrent attacks of extreme pain, swelling and redness

The following are used to assist with the treatment of gout

• Cold compress: The application of cold compress several times during the day may decrease the inflammation and reduce pain.

• Rest: To ease the pain during a gout attack, rest and elevate the joint that hurts.

PREVENTION

Patients suffering from gout will benefit in the long term from healthy changes to their lifestyle, taking steps to decrease their uric acid level and keeping it low:

• Maintain a healthy body weight

• Exercise regularly (both muscle-strengthening and cardio)

• Cut down on alcohol consumption and avoid binge drinking

• Keep hydrated – drink plenty of water

• Follow a diet that limits purine-rich foods

• Manage high blood pressure

• Increase intake of vitamin C-rich foods

• Add low-fat dairy products to your diet

• Avoid fructose (a type of sugar found in soft drinks, sweets, cookies, etc)

• Use aspirin sparingly.

Medicines used to treat acute attacks

• NSAIDs: Taken at the beginning of an attack NSAIDs ease pain and help to reduce inflammation. These drugs should be taken with food, as they can erode the lining of the stomach. Care should be taken in elderly people, especially those with kidney problems. NSAIDs reduce the inflammation caused by deposits of uric acid crystals but have no effect on the amount of uric acid in the body. Do not use aspirin as it may change uric acid levels in the blood and may make the attack worse.

• Colchicine isn’t a painkiller, however it is often effective at decreasing inflammation caused by the crystals interacting with the joint lining. There is usually a dramatic response to oral colchicine. Joint pain generally begins to subside after 12 hours of treatment and is gone within 36-48 hours. A low daily dose of colchicines can prevent future attacks.

• Corticosteroids: If NSAIDS and colchicine are ineffective, sufferers should see their general practitioner who can prescribe corticosteroids. The drugs can be administered orally or injected directly into the inflamed joint. Corticosteroids can be prescribed to patients who have accompanying kidney, liver or gastrointestinal problems. Corticosteroids usually provide rapid relief from gout symptoms. However, because of their potential side effects if used for a long time, corticosteroids are usually prescribed only for a short time.