Whenever there is talk of Arthritis, the association with Rheumatoid Arthritis and Osteoarthritis is most often drawn. However one of the oldest forms of Arthritis is still around and still as painful. Gout or gouty arthritis has been described since Hippocrates in the 5th century B.C. At one time the term Gout had the distinction of being used to describe all types of Arthritis. The association between gout and uric acid was known since the 19th century. However it wasn’t until scientists were able to understand the biochemistry of the uric acid production by the body in the 1960’s, that effective therapy for gout was discovered. Today Gout remains one of the most treatable forms of Arthritis.
Gout is one of the most painful rheumatic diseases. It comes in the form of acute arthritis that causes sudden and recurring attacks of severe pain and swelling in the joints. The most commonly affected joint is the big toe, even though other joints on the foot, leg, arms and hands can be affected. This is the results of deposits of needle-like crystals of uric acid in connective tissue, in the joint space between the two bones or in both. Gout is often characterized as an overload of uric acid in the body and recurring attacks of joint inflammation. The uric acid deposits can lead to inflammatory arthritis, which causes swelling, redness, heat, pain and stiffness in joints.
Uric acid is a waste product that results from the breakdown of purines, which are part of the human tissue and found in some foods. Normally uric acid is dissolved in the blood and passed through the kidneys into the urine, where it is eliminated. But, sometimes the kidneys can’t eliminate enough of the uric acid, either because the body increases its production of uric acid or the kidneys are not eliminating enough uric acid from the body. That’s when the levels of uric acid builds up in the blood, creating a condition called Hyperuricemia. This condition can also happen when a person eats too much high- purine foods, such as anchovies, sardines or scallops. By itself this condition is not a disease and is not dangerous. However high levels of uric acid in the blood cause crystals, which are called urate crystals, to form and gout can develop. Redness, pain and swelling occur when white blood cells surround and attack the urate crystals. Deposits of uric acid called tophi can also appear as lumps under the skin at the rim of the ear. In addition, urate crystals can collect in the kidney and cause kidney stones.
Gout affects the big toe of about 75 percent of its patients. It can also affect the instep, ankles, heels, wrists, fingers and elbows. Gout progresses through four stages, Asymptomatic, Acute Gout, Intercritical Gout and Chronic Tophaceous Gout.
The Asymptomatic hyperuricemia stage is where the person has elevated levels of uric acid in the blood but no other symptoms. This stage does not require treatment.
Acute Gout happens when the uric acid crystals are deposited in the joints. This leads to intense pain and swelling in the joints. This attack often happens in the night and can be triggered by stressful events, alcohol or drugs. Within three to ten days this attack can stop even without treatment. The next attack may not occur for months or even years. However with each passing year the attacks can happen more frequently or last longer.
Intercritical Gout is the period between acute attacks
Chronic Tophaceous Gout is the most debilitating stage of gout. This stage usually develops over a period of ten years or more. At this stage, there is permanent damage to the affected joints, due to cartilage and bone destruction, which sometimes can lead to deformity.
Those who suffer from gout must be careful as Pseudogout and bacterial cellulites can sometimes mimic Gout.
Pseudogout produces similar symptoms of inflammation. It affects the knees, wrists, ankles, shoulders and hips. The affected areas are characterized by acute joint swelling, warmth, stiffness and pain. However the deposits are made up of calcium phosphate crystals not uric acid, and as such treated differently.
Bacterial Cellulite is an inflammation of the connective tissue underlying the skin. It produces symptoms like swelling redness, warmth, and pain. Affecting areas like the arms, leg and face. This condition can last from days to weeks and is treated differently.
Treatment of gout can be seen as non-medicated and medicated.
The non-medicated aspects of treating gout are the reducing of alcohol consumption and dietary changes. This includes scaling back on foods rich in purine, i.e. sardines, scallops and shellfish among others, which helps to reduce the uric acid levels in the blood.
Weight reduction can also be helpful, if this can be done by reducing dietary fat and calorie intake, combined with a regular aerobic exercise program. The weight reduction helps to lower the risks of reoccurring attacks of gout.
The medicated aspects start with the use of pain relievers to control pain. Acetaminophen / Tylenol or more potent analgesics are used to manage pain. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen sodium or indomethacin are used effectively in reducing joint inflammation.
Colchicine is also used but not as frequently as NSAIDs, to treat gout. It has been used since the 1800’s. When used it is very effective. However its side effects such as nausea, vomiting and diarrhea, after a short time, makes it intolerable for some people.
Finally, there is medication that can be used to manage the metabolic derangement that causes hyperuricemia and gout. This form of treatment reduces the elevated levels of uric acid in the blood
The underlying cause of gout is still unknown. It is known though, that the build up of urate crystals and the depositing of these crystals in the space between the joints causes acute gout. If one should have to live with gout, life style changes can make it easier to live with this lifetime disease. However they are a number of risk factors related to the development of hyperuricemia and gout that one should be aware of:
• Gender and age are related to the risk of developing gout. It is more common in men than in women and more common in adults than in children.
• Genetics can play a role in determining a person’s risk, as eighteen percent of people with gout have a family history of the disease.
• People who are overweight increases the risk of developing hyperuricemia and gout as the body produces more uric acid due to the availability of more tissue.
• The consumption of excessive amount of alcohol interferes with the removal of uric acid from the body.
• Food rich in purines can cause or aggravate gout in some people.
• Exposure to lead in the environment can also cause gout.
• Also certain diseases, such as blood cancers and some types of kidney disease, cause uric acid to build up.
At this moment there is no cure for gout, but active research is ongoing in a variety of fields related to gout. New medication to increase the elimination of uric acid in urine, and lowering the acid level in the blood are being tested. Research scientists are also working to develop less toxic and more effective medication to battle this disease. It is important to remember that you should form close ties with your doctor and therapist, while becoming full partners in their treatment, which is, living well with Gout.
Reference:
- Arthritis Foundation Arthritis National Research Foundation
