Gouty Arthritis

WHAT IS GOUT

Gout is a kind of arthritis. As a pain medicine specialist we commonly see 4-5  gouty arthritis paitients in our OPD per month. Increase in uric acid levels in the blood is called hyperuricemia and when these urate crystals get deposited in the joints it causes inflammation and pain leading to gout or gouty arthritis. However, it’s not necessary that a person will have GOUT if he has hyperuricemia. The Urate Crystals can also cause painless disfiguring lumps under the skin around the joints called Tophi. They can also form kidney stones.

GOUT SYMPTOMS

Gout attacks generally attacks a single joint, but people may develop multiple inflamed joints at the same time. The pain reaches its peak within 12-24 hrs and then gradually improves on its own over a period of few days even if left untreated. People with gout are at increased risk of developing kidney stones, high Blood Pressure, and heart diseases.

GOUT RISK FACTORS — Gout usually develops in adulthood and occurs. It commonly in men at ages 30 to 45 years and in women usually after age 55.

There are several medical conditions and lifestyle choices that increase the risk of developing gout, including:

1. Obesity
2. High blood pressure
3. Chronic kidney disease
4. Consuming excessive alcohol (beer, whiskey, vodka, or rum) on a regular basis
5. Consuming large amounts of meat, seafood, or beverages containing high fructose corn syrup
6. Taking medications that affect blood levels of urate (especially diuretics)

GOUT DIAGNOSIS

There are many illnesses that can cause joint pain and inflammation. We need a strong clinical suspicion to diagnose Gout.  Acute monoarticular pain in a patient with prior history of hyperuricemia is sufficient to suspect gout. Blood uric acid are ordered but may be normal during an acute attack. To diagnose Gout, the synovial fluid is collected from the affected joint and examined for the presence of urate crystals.

Treatment:

Treating gout requires a two-pronged approach that combines medications and lifestyle changes.

Treating an Acute Gout Attack

Here are the steps for getting the pain and swelling of a gout attack under control:

• Take an anti-inflammatory medication as soon as possible
• Ice and elevate the joint
• Drink plenty of fluids (no alcohol or sweet sodas)
• Call your doctor and make an appointment

Here are the medications used to treat an acute gout attack.

• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs are frequently used to quickly relieve the pain and swelling of an acute gout episode and can shorten the attack, especially if taken in the first 24 hours.
• Corticosteroids: Corticosteroids can be taken by mouth or injected into an inflamed joint to relieve the pain and swelling of an acute gout attack. They can also be injected systemically if the attack doesn’t respond to other medications or if many joints are affected.
• Colchicine: Colchicine helps to relieve the pain and swelling of acute attacks. Colchicine’s most common side effects are diarrhea, nausea, and abdominal cramps.

REDUCING URIC ACID LEVELS

• Allopurinol reduces the production of uric acid.
• Febuxostat may be an option if you develop side effects from allopurinol or have kidney disease. Like allopurinol, febuxostat decreases the amount of uric acid made in the body.
• Lesinurad is an oral drug that helps the body eliminate uric acid. It’s used with a xanthine oxidase inhibitor (XOI), such as allopurinol or febuxostat, to enhance the effects for people whose gout is not controlled by optimally dosed XOIs alone.
• Pegloticase is used when standard medications are unable to lower the uric acid level, a condition known as refractory chronic gout. The drug is administered every two weeks by intravenous (IV) infusion.

DIET:

Take

• Skim milk and other low fat dairy products
• Whole grain foods
• Plant oils (olive, canola, sunflower)
• Vegetables
• Citrus fruits

Avoid

• Red meat and organ meat (liver, tongue and sweetbreads)
• Seafoods
• Sugary beverages
• Excessive alcohol

For more details mail us at www.painxtotal@gmail.com or WhatsApp Dr. Anurag Aggarwal @9958830005 or visit our clinic Aggarwals Gynae & Spine Pain Clinic, Indirapuram, website: www.painx.in