Gout is characterized by sudden, severe attacks of pain, redness, and tenderness in joints, often the joint at the base of the big toe. Gout — a complex form of arthritis — can affect anyone. Men are more likely to get gout, but women become increasingly susceptible to gout after menopause.
There are more than 100 types of arthritis. Gout is one type of arthritis.
Gout mostly occurs in males after the age of 30 years. Gout rarely occurs in females. In females Gout occurs after menopause.
- Gout is one of the most painful arthritis. It usually starts from joint of great toe. The painful episode lasts for few days. Pain starts suddenly followed by swelling and local redness.
- Gradually painful episodes becomes more frequent. At later stage pain and swelling can become persistent.
- When uric acid level rises significantly above 6.5 mg/dl in blood; uric acid crystals can get deposited in joint.
- Deposition of uric acid crystals leads to inflammation in joint. This results in Gout arthritis.
- Uric acid is present in normal humans also. It is a byproduct of protein metabolism. Due to genetic abnormality either uric acid is over produced or under excreted from kidney.
- This leads to high uric acid in patients. Most patients have reduced excretion of uric acid from kidneys.
- Definitive diagnosis of Gout can be made only after visualization of uric acid crystals in fluid aspirated from joint. If the fluid cannot be aspirated from small joint than clinical diagnosis can be made from typical symptoms of this arthritis.
- Diagnosis CANNOT BE MADE in patients who have high uric acid but NO SYMPTOMS of arthritis.
- Uric acid levels are measured in Urine collected over 24 hours to determine etiology.
- Blood counts, liver functions and renal function is routinely before starting treatment. All patients are screened for diabetes, hypertension and high cholesterol.
Gout is treated in two steps.
- To reduce pain as soon as possible
- To control disease such a way that painful episodes never recurs
- Anti inflammatory drugs like Diclofenac, Naproxen, Indomethacin, Etoricoxib etc. is used to reduce pain.
- In patients who have abnormal kidney functions short course of steroids or steroid injection in large joint can be used.
- Colchicine drug is used to prevent painful episodes recurrence.
- To control the disease and prevent painful episodes uric acid in blood should be maintained below 6.5 mg/dl.
- Urate lowering drugs like Allopurinol, Fabuxostat are used to control the disease. All patients don’t need these drugs. Both drugs are equally effective. In patients with abnormal kidney function Fabuxostat is preferred.
- Vegetarian patients can eat all food INCLUDING pulses in normal proportions.
- For non vegetarians fish/ chicken are preferable. They should avoid mutton/ beef etc.
- Fatty food should be avoided.
- Alcohol aggravates the gouty arthritis and should be avoided.