Definition of Gout
Gout is one of two crystal-induced types of inflammatory arthritis. The crystals found in gout are called sodium urate monohydrate crystals. It is one of the most debilitating forms of inflammatory arthritis.
It is commonly an adult-arthritis disease. Historically, it was known as the ‘disease of the kings’. This was because of their overindulgence in debauchery and binge eating. This misconception has been corrected. Gout can affect any individual with risk factors and have the presence of urate crystals in the joints.
Causes of Gout
The etiological factors of gout are based on their tendencies to raise the levels of uric acid in the blood above the normal range. Levels of uric acid in the blood are determined by two main factors:
- Production of uric acid
- Excretion of uric acid
Impairment in either of the two mechanisms would lead to excessive accumulation of uric acid in the blood. Common risk factors include:
- Use of NSAIDs
- Drinking alcohol
- Use of diuretic drugs e.g. Lasix
- Use of immunosuppressors e.g. cyclosporine
- Women in their menopause
- Comorbidities e.g. DM, HTN, increased blood cholesterol levels
- Genetic predisposition
- Kidney disease
Symptoms of Gout
Elevation of uric acid in the blood may occur without symptomatic arthritis. However, when uric acid urate crystals accumulate in the joint spaces, then a severe form of arthritis is inevitable.
- Excruciating pain building up over the first 10 hours of onset is a classical symptom of gout.
- Onset of pain often begins at night
- The big toe is the primary site of gout arthritis
- Other joints can be affected e.g. ankles, knees, wrist etc.
- Arthritis can be migratory
- The pain is intense
- The joint region is markedly swollen. The swelling may be a deposition of the sodium urate crystals forming a bulge on the toe that is referred to as tophi.
- The skin on the affected joint is typically warm, red and hot.
The skin is also extremely tender to superficial touch, shiny and may easily peel off
Treatment of Gout
With gout, the goal of treatment is to relieve the symptoms and maintain the uric acids levels at therapeutic levels <6mg/dL. We strongly suggest consulting with Dr. Burke when you experience the above symptoms. He tailors gout management to the specific needs of the patient as well as the current status of the disease. Pharmacologic intervention in gout is time-specific. His therapeutic plan may include:
- Lifestyle modification e.g. eating habits, weight loss habits etc.
- Use of NSAIDs
- Use of systemic steroids
- Local steroid injections