What is Gout and Why Does it Hurt so Much?
What is Gout and Why Does it Hurt so Much?By Nathan Wei
Gout is a type of arthritis that is caused by a buildup of uric acid. High levels of uric acid in the blood can lead to build up of crystals of uric acid in the joints. These crystals can cause extremely painful attacks.
Elevated blood uric acid results from either over production or under excretion of uric acid.
Crystals of uric acid may deposit as a result of fluctuations in temperature, pH levels in the body, and dehydration.
Acute attacks occur when uric acid crystals cause an acute inflammatory response.
Triggering factors include either increases or sudden decreases in uric acid levels in the blood, an increase in dietary intake of foods high in purines, and joint trauma.
There are three major stages of gout.
The first stage is what is called asymptomatic hyperuricemia. This is when the blood uric acid level is elevated but the patient has no symptoms.
The second stage of gout is acute intermittent gout. This stage begins with the first attack of gout. Attacks are separated by symptom free periods. During this stage of gout, uric acid crystals are present in joints and low-grade inflammation often persists. During this stage, gout can progress.
The final stage is advanced gout. This is when the periods between attacks no longer are pain free. This stage is characterized by chronic pain, arthritis affecting many joints, joint damage, and the development of tophi- deposits of uric acid under the skin.
Gout attacks usually occur in the big toe joint but can also occur in other areas including the ankles, knees, hands, wrists, as well as other joints.
Attacks can occur without warning signs and the pain, swelling, and redness can last several hours, several days, or even weeks.
If elevated uric acid levels persist, crystals can build up in the joints between attacks and cause severe joint destruction. Over time, attacks of gout become more frequent, last longer, and begin to affect other joints.
Uric acid comes from foods that are high in a substance called purines. Foods and drinks that are high in purines need to be avoided. Examples of foods that are high in purines include meats such as beef, pork, lamb as well as beer, wine, shellfish, and canned tuna.
Eating too much of these types of foods can elevate blood uric acid levels and trigger flares.
While a diet low in purines may help lower uric acid, this may not be enough.
The first step in gout treatment is making the diagnosis. This may require examination of joint fluid obtained through needle aspiration of an inflamed joint. This procedure should be done using ultrasound guidance in order to minimize patient discomfort.
Once the diagnosis is made, there are two goals that are needed in order to treat gout optimally.
The first is to reduce the pain and swelling from gout flares.
Medications such as non-steroidal anti-inflammatory drugs or NSAIDs, colchicine, and steroid drugs can help reduce swelling and pain.
The other goal is to lower the blood level of uric acid and keep it at a low level, generally below 6 mg/dL.
It is important to monitor blood uric acid levels during treatment in order to make sure that the blood uric acid remains below 6.0 mg/dL.
During initial gout treatment, it is recommended that prophylactic treatment with either colchicine or non-steroidal- anti-inflammatory medicines is used for at least six months.
Medicines such as allopurinol and febuxostat (Uloric) are usually the drugs of choice.
In younger patients, where kidney function is normal, and over excretion of uric acid in the urine is not a problem, probenecid may be acceptable.
It is important for both the patient as well as the physician to constantly monitor the effects as well as the side effects of medication.
About the Author: Nathan Wei, MD FACP FACR is a board-certified rheumatologist and nationally known arthritis authority and expert. For more info: Arthritis Treatment and Arthritis Treatment Center
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