Gout

What is Gout?

Sudden and severe attacks of pain, redness and tenderness in the joints especially at the base of the big toe is considered to be Gout. Some individuals may wake up in the middle of the night feeling that their big toe is on fire. The affected joint can feel tender to the touch and individuals may experience difficulty turning over in bed. The most commonly affected joints are the big toe, foot, ankle, heel, instep and knee. Gout rarely affects joints in the upper limbs like fingers or wrists.

Causes

When the kidneys face difficulty in excreting excess uric acid in the urine, it can become deposited in the joints. This then causes it to form Tophi crystals which in turn cause swelling and pain. Other causes of Gout can include:

- A diet that is too rich in proteins, fat, and alcohol

- Certain medications

- Gender — Men are more likely to get gout, but women have a higher risk of getting gout after menopause

- Hereditary — Gout often runs in families because of a genetic connection

- Other diseases such as Diabetes, Hypertension, Leukaemia and Kidney Disorders

Symptoms

The first syins of Gout is a sudden and severe warm throbbing of the affected joint and the pain can quickly become excruciating. The joint will swell and become red as well. Other symptoms can include:

- Difficulty and pain in walking during an acute attack

- Extremely large uric acid crystals or Tophi in the joints or other tissues

- On-going (chronic) pain with reduced movement in the involved joint

- The skin around the joint being tender, sensitive, and sore, and extremely painful to touch

- The initial episode usually subsides completely within a week.

Treatment

Currently, there is no cure for Gout, but the sympytoms can be well managed through a combination of medication and specialised diet such as below:

- A ‘Low-Purine’ Diet is recommended to reduce the level of Uric Acid in the blood (Purine is broken down by the body where it is changed to Uric Acid): Avoid foods that are rich in Purine such as alcohol, liver, kidney, salmon, sardine, dry beans, bean curd and soya bean drink

- Limit your daily intake of protein-rich food such as red meat

- Colchicine (an Anti-Gout Medicine) is effective for relieving acute pain and can also prevent acute attacks - Non-Steroidal Anti-Inflammatory Drugs to reduce the pain, swelling, and stiffness

- Steroids can be used for an acute attack, and can be injected directly into the joint if the pain is extreme

- Surgery is rarely used to treat Gout, but may occasionally be needed to remove infected uric acid crystals, or those that interfere with joint movement

- Uric acid crystals tend to recur unless the high uric acid level in your blood is reduced.

Complications and Related Diseases
If left untreated, your joints may become damaged causing deformity and restricting your mobility. Uric acid crystal deposits can also form under the skin in nodules causing infection. Gout episodes can become more frequent especially if high uric acid levels is not reduced. The crystals can also collect in the urinary tract, causing kidney stones. If you have chronic gout, you may also have kidney function or kidney faulure and high blood pressure.

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