GOUT

BY DEEKSHA SINGH

B.PHARMA

INTRODUCTION The word "gout" is derived from the latin word gutta, meaning

"a drop" (of liquid). Gout was historically known as "the disease of kings" or "rich

man's disease". Several hundred years ago gout was thought to be caused by

drops of viscous humors that seeped from blood into the joints. In fact, this supposition was not that far from the truth.

Gout is a medical condition usually characterized by recurrent attacks of acute inflammatory arthritis-- a red, tender, hot,swollen joint.

The most commonly affected (approximately 50% of cases) part is the metatarsal-phalangeal joint at the base of the toe.

However, it may also present as tophi, kidney stones, or urate nephropathy.

Gout is also known as podagra when it involves the big toe. Gout is more prevalent among men.

CAUSES High levels of uric acid in the blood is

the main cause of gout. When the human body breaks down

chemicals called purines it produces uric acid.

Purines can be found naturally in our body, as well as in food, such as organ meats, anchovies, asparagus, mushrooms and herring.

Most of the time uric acid dissolves and goes into the urine via the kidneys. However, if the body is producing too much uric acid, or if the kidneys are not excreting enough uric acid, it builds up.

The accumulation results in sharp urate crystals which look like needles. They accumulate in the joints or surrounding tissue and cause pain, inflammation and swelling.

The uric acid crystallizes, and the crystals deposit in joints, tendons, and surrounding tissue. The following have been known to bring about a gout attack and may be contributory causes of gout: o obesityoHeavy alcohol consumption, especially beeroDiet high in purin foodoRegular aspirin useoregular use of diuretic medicinesoTumorsolead poisoningosurgery

SIGNS & SYMPTOMS Signs and symptoms of gout are generally acute - they come on

suddenly without warning. A significant proportion of patients experience them at night.

Severe pain in the joints - The patient may experience pain in his ankles, hands, wrists, knees or feet. More commonly the big toe is affected (podagra). Many patients describe the affected areas as warm/hot.

Gradually goes away - A bout can last for over a week if left untreated - and then gradually goes away during the following week or two

Itchy and peeling skin later - As the gout subsides the skin around the affected area may be itchy and peel.

Redness and inflammation - The sufferer will most likely have tender, red and swollen joint(s) in the areas that experienced the most pain.

Fever - Some patients have an elevated temperature. Less flexibility - The affected joint may be harder to use, the patient has

limited movement. Joint pain usually begins over 2–4 hours and during the night. The reason

for onset at night is due to the lower body temperature then.

DIAGNOSISGout may be diagnosed and treated without further investigations in someone with hyperuricemia and the classic podagra. Synovial fluid analysis should be done, however, if the diagnosis is in doubt.Blood test - to measure our levels of uric acid. This test is not definitive as some people with high uric acid levels never have gout symptoms; while others who have gout symptoms do not have high levels of uric acid in their blood. Joint fluid test - a needle is used to collect fluid from the affected joint. The liquid is then examined under a microscope to see whether urate crystals are present.  x-rays are also done useful for identifying chronic gout.

Gout on x-ray of left foot

Spiked rod of uric acid photograph

ed under microscope

TREATMENTThe initial aim of treatment is to settle the symptoms of an acute attack. Repeated attacks can be prevented by different drugs used to reduce the serum uric acid levels. Ice applied for 20 to 30 minutes several times a day decreases pain. however, 60% of people have a second attack within one year. Those with gout are at increased risk of hypertension, diabetes mellitus, metabolic syndrome, and renal and cardiovascular disease, thus are at increased risk of death. for acute treatment include nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine and steroids. Without treatment, an acute attack of gout usually resolves in five to seven days.

PREVENTION Both lifestyle changes and medications can

decrease uric acid levels. Reduce intake of food such as meat and

seafood, consuming adequate vitamin C limiting alcohol and fructose consumption, and avoiding obesity.

A low-calorie diet in obese men decreased uric acid levels by 100 µmol/l (1.7 mg/dl).

Vitamin C intake of 1,500 mg per day decreases the risk of gout by 45%.

Coffee, but not tea, consumption is associated with a lower risk of gout.

CONCLUDING Gout has become more common in recent decades,

affecting about 1–2% of the western population at some point in their lives. The increase is believed due to increasing risk factors in the population, such as metabolic syndrome, longer life expectancy and changes in diet.

If we have a sudden and intense pain in a joint get in touch with our doctor. If we do not treat it, the gout can gradually get worse over time. If we also have a temperature, and the joint is hot and/or inflamed, get medical attention as soon as possible as it may be an infection.

More important is to prevent the diease as we know prevention is better then cure

PICTURES OF GOUT

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