Information on gout
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Gouty arthritis is a metabolic disease, the hallmark of which, are uric acid deposits in the joints. The disorder causes painful arthritis, especially in the joints of the feet and legs.
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 condition may also develop in people with diabetes, obesity, sickle cell anemia, and kidney disease, or it may follow drug therapy that interferes with uric acid excretion.
Gout has 4 stages: asymptomatic (without symptoms), acute, intercritical, and chronic.
The asymptomatic stage occurs when patients have elevated levels of serum uric acid but do not have symptoms. This stage can progress for many years.
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 over several days, but may reoccur at irregular intervals. Subsequent attacks usually last longer. Some people may progress to chronic gouty arthritis, while others may have no further attacks.
The risk is greater in men, postmenopausal women, and people who use alcohol.
Joint pain usually begins suddenly and affects 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 joints are most often affected
Joint swelling accompanies the pain. Stiffness of the joint may be seen along with a warm and red appearance. In some patients,
fever may be present. In long-standing gout, tophi (lumps of uric acid) appear under the skin and drain chalky material.
Signs and tests
A physical examination of the joints shows acute arthritis.
• Synovial fluid analysis shows uric acid crystals.
• Uric acid (blood test) may be elevated.
• Joint X-rays may be normal.
The goals of treatment are to stop the pain and inflammation associated with the initial attack, and to prevent future attacks.
Colchicine is one of the medications that is effective in reducing the pain, swelling, and inflammation associated with acute gout attacks. The pain often 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.
Uric acid lowering therapies should not started during an acute attack since they can aggravate the attack.
Probenecid is a uric acid lowering drug given to patients with normal kidney function who don't already excrete a lot of uric acid in the urine.
Allopurinol is a drug that suppresses uric acid production. It works well but has many potential side effects including damage to the liver and bone marrow.
Febuxostat (Ulkoric) is a drug that works in a similar fashion to allopurinol but has fewer side effects.
PEG-uricase (Krystexxa) is an intravenously administered drug reserved for patients with severe refractory gout. It converts uric acid to allantoin, an inert ingredient excreted by the kidneys.
Non-steroidal anti-inflammatory drugs (NSAIDs) can be very effective in treating the pain and inflammation of an acute gout attack if taken soon after symptoms start.
Corticosteroids can also be very effective. They can be given either orally or injected into the inflamed joint to relieve the pain.
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 shellfish contain high levels of purines.
Adequate treatment of acute attacks allows people to live a normal life. The acute form of the disease may progress to chronic disease. Since uric acid is normally eliminated by the kidneys, chronic gout may lead to formation of uric acid kidney stones.
Complications of gout are:
1. Side effects of medications
2. Chronic gouty arthritis
3. Kidney stones
4. Kidney damage
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