Gout is a common type of arthritis. It is among the so called lifestyle disease. It has also been referred to as the disease of kings. This is because in most cases, gout is associated with affluence than with anything else. The onset of the disease is sudden and many patients will talk of being woken up by a severe pain in one of their big toes. Some will say that they felt like their toe was being sawed-off.
The typical joint pains occur when urate crystals accumulate and get trapped in the joint spaces creating a ‘grinding’ process in the joint and sudden inflammation.
- Sudden onset of severe pain usually at night and involving one of the big toes.
- Joint is swollen red and hot. It is very painful to touch and stiff
- Skin changes around the affected joint and sometimes there is peeling
- Other joints that can be affected include the wrist, the elbow and the ankle joints
- Swellings on the ear called tophi may also be seen.
Causes of gout
The main pathology in gout arthritis is when the levels of urate in the body rise above normal levels. This can either be due to too much urate creation or poor excretion through the kidneys. The sudden onset of symptoms is usually a culmination of a long standing buildup of urates that have now found their way into the joint cavity. Without intervention, this will lead to joint cartilage destruction and changes like those seen in osteoarthritis. Risk factors that can lead to gout arthritis include:
- Some people inherit a disorder where kidneys are unable to clear urates fast enough
- Prolonged use of diuretics
- Other diseases associated with lifestyle such as diabetes, high blood pressure, high cholesterol levels and the metabolic syndrome disorder.
- Excessive alcohol consumption
- Chronic fever
True gout must be differentiated from a condition called pseudo-gout where instead of urate crystals causing the problem, crystals of calcium pyrophosphate are deposited in the joint spaces instead. This usually accompanies osteoarthritis and is more common in bigger joints.
Gout arthritis diagnosis is usually made based on the history and clinical presentation. Laboratory tests will reveal high urate levels.
Synovial fluid examination may show urate crystals which can also be demonstrated from tophi examination.
Affected joint X-rays will reveal joint changes if the problem is a longstanding one.
Treatment of gout arthritis
During acute attack
- Use of common anti-steroidal anti-inflammatory drugs (NSAIDs) is started as early as possible.
- Colchicine is a strong anti-inflammatory drug that reduces gout inflammation effectively and fast. Do not use at the same time with any NSAIDs
- Corticosteroids are given if the response to colchicine or the NSAIDs is not satisfactory.
- Cold compresses on the affected joint can give temporary relief.
- Lifestyle changes such as reducing weight, reducing or stopping alcohol consumption, reduction of excess consumption of beef roast, a lot of fish and managing other risk factors can all help reduce gout arthritis recurrent attacks.
- Other drugs that can be taken daily to keep the levels of urates low are allopurinol and febuxostat
Other interventions may involve treatment of specific joint damage if it has occurred. If this are combined with a healthy diet and weight, most of the gout symptoms can be abolished and the disease can go into indefinite remission.