Gout

What is Gout?

There are more than 100 types of arthritis. Gout is one type of arthritis.

Who can get Gout?

Gout mostly occurs in males after the age of 30 years. Gout rarely occurs in females. In females Gout occurs after menopause.

What are the symptoms of Gout?

• 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.

What is the cause of Gout?

• When uric acid level rises significantly above 6.5 mg/di in blood; uric acid crystals can get deposited in joint.
• Deposition of uric acid crystals leads to inflammation in joint. This results in Gouty arthritis.

Why uric acid increases in body?

• 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.

How Gout is diagnosed?

• 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.

What other investigations are routinely done in patients of Gout?

• Uric acid levels are measured in 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.

What is the treatment of Gout?

Gout is treated in two steps.

• To reduce pain as soon as possible
• To control of disease such a way that painful episodes never recurs

What drugs are used to relieve pain?

• Anti inflammatory drugs like Diclofenac, Naproxen, lndomethacin, 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.

What drugs are used to control the disease?

• To control the disease and prevent painful episodes uric acid in blood should be maintained below 6.5 mg/di.
• Urate lowering durgs 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.

What food should be avoided by patients with Gout?

• 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.