Gout – Causes, Symptoms, Pathogenesis, Prevention and Treatment

‘Gout‘ is a form of arthritis caused by unusual deposition of uric acid crystals in the tissues and synovial fluids of the joints due to metabolic disorder. This results in the inflammation, swelling and pain in the joints. It affects almost all the joints in the body but the most common joint being the big toe of the foot. Men are more affected than the women. It is commonly seen at 30-50 years aged people. Some times it is seen in some families suggesting a genetic factor.

Acute uric acid arthritis at a patient’s right leg

Pathogenesis of Gout:

Gout is caused due to deposition of uric acid crystals in the joint tissues and fluids producing inflammation, swelling and pain of the joints. In the normal metabolism of proteins in the body, the end products urea, purines and creatinine are eliminated through urine. The main end product is urea a crystalline compound excreted through urine. But to faulty nutrition in gout patients the uric acid is produced in high levels and accumulated in the blood. The kidneys fail to expel the large quantities thereby uric acid crystals are deposited in the joint tissues producing the symptoms of gout.

Causes for Gout:

• Accumulation of uric acid in the blood due faulty metabolism.
• A genetic factor may be involved for the faulty metabolism.
• Life style changes and consuming high protein diet particularly non vegetarian diet.
• Alcohol abuse.
• Dysfunction of the kidneys and failure to excrete the uric acid.
• Obesity is also a predisposing factor for the onset of gout.
• Certain medications like antibiotics, diuretics and drugs used for chemotherapy may also cause gout.

Symptoms of gout:

• Sudden pain, inflammation and swelling of the joints usually the big toe of the foot.
• Fever and general malaise.
• In chronic cases it occur intermittently affecting more than one joint like knees, shoulder joints.
• Reduction of mobility of the affected joints.

Diagnosis of gout:

Diagnosis is usually made by the presence of classical symptoms and testing of the blood shows high levels of uric acid. Uric acid crystals can also be seen in the joint fluids. ‘X’ ray studies help to detect the tissue and bone damage in chronic cases.

Treatment of gout:

Treatment is aimed to reduce the production in the body and enhance elimination of uric acid by the kidneys. For controlling the pain and swelling non steroidal anti inflammatory drugs (NSAIDS) are given. In persistent cases corticosteroids are also given either orally or into the joints to reduce pain and inflammation. In chronic cases drugs like allopurinol, clochicine are given to reduce the production of uric acid in the body and enhance its elimination. These drugs produce severe side effects in long term usage. As such they should be used only under a qualified physician. Drinking of 8-10 glasses of water helps in dilution of urine and help in lowering the uric acid levels.

Preventing the attack of Gout:

• Avoid non vegetarian food especially purine rich diet, fats legumes, cauliflower and mushrooms.
• Reduce alcohol intake.
• Exercise programs to reduce weight in obese persons.
• Regular check up and blood tests.

Alternate methods for treating Gout:

• Hot and cold fomentations of the affected joints reduce pain and swelling and help the patient to feel comfortable. An electric hot pad can conveniently be used. Alternately if hot pad is not available hot water fomentation can be given with a turkey napkin. Cold fomentation can be given with ice packs used to pack the vaccines, hormones and other perishables to keep cool.
• Ayurvedic and homeopathy can be tried under treatment with qualified people.
• Supplements like Vitamin C, and Vitamin K can also be taken under doctor’s guidance.