GOUT : Uric Acid

If you wake up in the middle of the night, and your big toe feels as if it's on fire. It's hot, swollen and so tender that even the weight of a blanket on it seems intolerable. These problems could indicate an acute attack of gout or gouty arthritis a form of arthritis that's characterized by sudden, severe attacks of pain, redness and tenderness in joints.

Arthritis Gout

Gout is condition that results from crystals of uric acid depositing in tissues of the body. Gout is characterized by an overload of uric acid in the body and recurring attacks of joint inflammation ( arthritis ). Chronic gout can lead to deposits of hard lumps of uric acid in and around the joints, decreased kidney function, and kidney stones.
Gout has the unique distinction of being one of the most frequently recorded medical illnesses throughout history. It is often related to an inherited abnormality in the body's ability to process uric acid. Uric acid is a breakdown product of purines, that are part of many foods we eat. An abnormality in handling uric acid can cause attacks of painful arthritis (gout attack), kidney stones, and blockage of the kidney filtering tubules with uric acid crystals, leading to kidney failure. On the other hand, some patients may only develop elevated blood uric acid levels ( hyperuricemia ) without having arthritis or kidney problems. The term "gout" commonly is used to refer to the painful arthritis attacks.
Gouty arthritis is usually an extremely painful attack with a rapid onset of joint inflammation. The joint inflammation is precipitated by deposits of uric acid crystals in the joint fluid and joint lining ( synovial lining ). Intense joint inflammation occurs as white blood cells engulf the uric acid crystals and release chemicals of inflammation, causing pain, heat, and redness of the joint tissues

Who is affected by gout ?

Gout is nine times more common in men than in women. It predominantly attacks males after puberty, with a peak age of 75. In women, gout attacks usually occur after menopause.
While an elevated blood level of uric acid ( hyperuricemia) may indicate an increased risk of gout, the relationship between hyperuricemia and gout is unclear. Many patients with hyperuricemia do not develop gout, while some patients with repeated gout attacks have normal or low blood uric acid levels.
Risk..factors.

In addition to an inherited abnormality in handling uric acid, other risk factors for developing gout include obesity, excessive weight gain, especially in youth, moderate to heavy alcohol intake, high blood pressure, and abnormal kidney function. Certain drugs, such as thiazide diuretics, low-dose aspirin, niacin, cyclosporine, tuberculosis medications (pyrazinamide and ethambutol), and others can also cause elevated uric acid levels in the blood and lead to gout.

What are symptoms of gout ?

The small joint at the base of the big toe is the most common site of an acute gout attack. Other joints that can be affected include the ankles, knees, wrists, fingers, and elbows.
Acute gout attacks are characterized by a rapid onset of pain in the affected joint followed by warmth, swelling, reddish discoloration, and marked tenderness. Tenderness can be intense. Patients can develop fever with the acute gout attacks. These painful attacks usually subside in hours to days, with or without medication.
Uric acid crystals can deposit in tiny fluid-filled sacs ( bursae ) around the joints. These urate crystals can incite inflammation in the bursae leading to pain and swelling around the joints, a condition called bursitis. In rare instances, gout leads to a more chronic type of joint inflammation which mimics rheumatoid arthritis.
In chronic ( tophaceous ) gout, nodular masses of uric acid crystals ( tophi ) deposit in different soft tissue areas of the body. Even though they are most commonly found as hard nodules around the fingers, at the tips of the elbows, and around the big toe, tophi nodules can appear anywhere in the body.
How is gouty arthritis diagnosed ?

Gout is suspected when a patients reports a his- tory of repeated attacks of painful arthritis at the base of the toes. Ankles and knees are the next most commonly involved joints in gout. Gout usually attacks one joint at a time.
Normal uric acid blood level for men is 3.4-7 mg% and for women is 2.4-5.7 mg%. The above normal blood uric acid level is called hyperuricemia, and starting to deposit in the joints in our body.
The most reliable test for gout is finding uric acid crystals in the joint fluid obtained by joint aspiration (arthrocentesis). Arthrocentesis is a common office procedure performed under local anesthesia. Using sterile technique, fluid is withdrawn (aspirated) from the inflamed joint, using a syringe and needle.
The joint fluid is then analyzed for uric acid crystals and for infection. Shiny, needle-like uric acid crystals are best viewed with a polarizing microscope. The diagnosis of gout can also be made by finding these urate crystals from material aspirated from tophi nodules and bursitis fluid.
X-rays can sometimes be helpful, and may show tophi crystal deposits and bone damage as a result of repeated inflammations. X-rays can also be helpful for monitoring the effects of chronic gout on the joints.
Prevention and treatment.

Preventing acute gout attacks is equally as important as treating the acute arthritis. Prevention of acute gout involves maintaining adequate fluid intake, weight reduction, dietary changes, reduction in alcohol consumption, and medications to reduce hyperuricemia.
Maintaining adequate fluid intake helps prevent acute gout attacks. Alcohol is known to have diuretic effects which can contribute to dehydration and precipitate acute gout attacks. Alcohol can also affect uric acid metabolism and cause hyperuricemia.
Dietary changes can help reduce uric acid levels in the blood. Since purine chemicals are converted by the body into uric acid, purine rich foods are avoided. Examples of foods rich in purine ( to avoid / limit ) include seafood ( shrimp,crab,shellfish ) and organ meats, such as liver, brains, kidneys. Moderate purine ( to eat occasionally ) are asparagus, spinach, cauliflower, mushrooms, melinjo ( emping ), bird, duck, turkey. Researchers have reported, in general, that meat or seafood consumption increases the risk of gout attacks, while dairy consumption ( low fat milk, low fat yogurt ) seemed to reduce the risk. Alcohol intake was strongly associated with an increased risk of gout (beer and liquor were particularly strong factors).
Weight reduction can be helpful in lowering the risk of recurrent attacks of gout. This is best accomplished by reducing dietary fat and calorie intake, combined with a regular aerobic exercise program.
There are three aspects to the medication treatment of gout. First, pain relievers. Secondly, anti-inflammatory agents. Finally, medications are considered for managing the underlying metabolic derangement that causes hyperuricemia and gout.