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Gout
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Gout is a type of arthritis that is known for sudden onsets of severe pain, redness of the joint and joint tenderness. The most common form of gout occurs at the base of the big toe but other joints can be involved. Gout can affect any person but is more common in men. Women get gout more commonly after menopause.
Gout can be so severe that you are awakened from sleep in the middle of the night and it can feel as though you have your toe on fire. Even the weight of the sheet on the toe can be difficult to tolerate. Fortunately, there is treatment and preventative treatment for gout that you can take to control the episodes of severe pain.
Symptoms and signs of gout include intense pain in the affected joint. It usually affects one joint at a time and usually the joint at the base of the great toe. It usually comes on suddenly at night and can affect other joints, such as those in the wrist, hands, knees and ankles. It is severe in the beginning but gets slightly better after 24 hours. After that, there is discomfort that lasts for up to a few weeks. If you get subsequent attacks, it is generally more painful and can affect more joints. There is redness, tenderness and swelling of the joints.
The cause of gout is uric acid crystals that accumulate within the joints, causing inflammation of the joints and intense pain in the joint. Uric acid crystals happen because you have an elevated level of uric acid in the blood. Uric acid is the breakdown product of purines, which are believed to be made in the body as well as found in organ meat, anchovies, asparagus, mushrooms and herring.
Uric acid dissolves in the blood and passes through the kidneys. It is found in urine. If you have too much uric acid in the blood due to increased production or too little excretion of uric acid, you can build up crystals within the joints made up of urate.
Your personal increase in uric acid is related to your lifestyle. Too much alcohol too often can cause gouty arthritis. This means more than two drinks per day for men and more than one drink per day for women. If you have high blood pressure, diabetes and elevated cholesterol in your blood, you can get gouty arthritis. Using thiazide diuretics for high blood pressure can contribute to uric acid level increases. If you have a family history of gout, you have a personal higher history for the disease. It occurs more often in men than in women although women after menopause have a higher risk.
Complications of gout include getting recurrent gouty arthritis, which can be debilitating. Advanced gout involves the deposition of uric acid crystals under the skin in the form of nodules called tophi. Gouty tophi can become tender and swollen during attacks of gout. You can also get kidney stones from uric acid stones that build up in the urinary tract.
Tests for gout include joint fluid analysis that will show the crystals in the fluid. Blood tests will show an elevated uric acid level. It can be tricky, however, because some people show an elevated uric acid level but do not get gout and some people with gout will have normal uric acid levels.
The treatment of gout involves treating an acute attack and preventing further attacks. These include the taking of nonsteroidal anti-inflammatory medications that control the acute inflammation from gout. These can be prescription NSAIDs or over the counter NSAIDs like ibuprofen and naproxen. Colchicine is used if you cannot take NSAIDs, especially if you take it soon after getting the symptoms. There are a lot of side effects using this drug, however, including diarrhea, nausea and vomiting.
Low dose colchicine can prevent further attacks of gouty arthritis in some conditions. Corticosteroids can be used to control the pain and inflammation of gout. These are used in situations where NSAIDs or colchicine does not work or is not tolerated. There are side effects of steroids, including thinning of the bones, decreased ability to fight off infection and poor wound healing.
Preventative drugs for gouty arthritis include medications that block uric acid production. These include allopurinol and febuxostat. You also need to reduce the intake of purines in the diet in order to reduce the risk of getting gouty arthritis. Low dose colchicine also can prevent an attack of gouty arthritis. Another medication, known as Probenecid, increases renal excretion of uric acid.