Gouty Arthritis - High Uric Acid levels

What is gout?

Gout is a form of arthritis that is characterized by an attack of sudden stiffness, burning pain and swelling in a joint. The attacks repeat themselves unless treated. Over time, the joints, tendons and other tissues can get harmed. Though gout can affect anyone, it is more common in men. Women become susceptible to gout after menopause.

What are the causes of the disorder?

The body produces uric acid when it breaks down purines (substances found naturally in the body and in certain foods like meats, asparagus and mushrooms). In normal conditions, uric acid dissolves in the blood and passes out of the body through the kidneys into urine. However, sometimes the body produces too much uric acid and the kidneys are not able to excrete all of it. In this condition, uric acid builds up and forms urate crystals in joints. These needle-like crystals cause pain, inflammation and swelling.

Risk of developing gout is higher is people who:

1. Are overweight
2. Drink excessive alcohol
3. Eat a lot of fish or meat or foods rich in chemicals called purines
4. Take medicines like diuretics

What one needs to know about symptoms or signs?

Symptoms of gout are acute, and develop suddenly, mostly at night. Signs of gout include:

1. Intense joint pain - Gout most commonly affects the large joint of the big toe, but it may also occur in the feet, ankles, knees, wrists and hands. Pain is most severe in the first 12 to 24 hours.
2. Inflammation and redness - The affected joint is swollen, tender and red.
3. Discomfort - Once the initial pain of a gout attack subsides, joint discomfort remains for as long as few days to few weeks. Repeat attacks tend to last longer and affect more joints.

Which specialist should be consulted in case of signs and symptoms?

A rheumatologist is a specialist who can diagnose and treat arthritis and other inflammatory joint conditions.

What are the screening tests and investigations done to confirm or rule out the disorder?

Gout is diagnosed through the following:

1. Joint fluid test - The doctor inserts a needle into the joint to draw out synovial fluid (fluid between two bones in a joint) for further examination under a microscope to look for urate crystals.
2. Blood test - Blood tests can determine the levels of uric acid in blood. However, some people may show high levels of uric acid in blood without ever developing gout, and some people may show signs of gout but have normal levels of uric acid in blood.
3. Joint x-rays - An x-ray can point towards any abnormality in the joint.

What treatment modalities are available for management of the disorder?

Gout treatment is mainly carried out through medicines. The type of medication depends on the patient's health status and preferences. Gout medication is categorized into medicines that treat acute attacks and those that prevent future attacks and reduce the complications from gout.

Medications used against gout include:

1. Nonsteroidal anti-inflammatory drugs (NSAIDs) - NSAIDs are useful in controlling pain and inflammation. An initial high dose stops a gout attack while lower daily doses are continued to prevent any future attack. Both over-the-counter medication and prescription options are available.
2. Colcichines - This is recommended to alleviate symptoms as soon as they appear. However, side effects include nausea, vomiting and diarrhoea.
3. Corticosteroids - Corticosteroid medication like prednisone helps control gout inflammation and pain. They may be taken in pill form or given through injections. They are given to patients who are unable to take NSAIDs or colcichines.

What are the known complications in management of the disorder?

Patients may develop more severe conditions like:

1. Recurrent gout - While some patients do not experience another gout attack, others may undergo gout more than once a year. Preventive medication is prescribed in such cases.
2. Advanced gout - When left untreated, urate crystals can form under the skin in form of nodules known as tophi. These can also develop in hands, feet, elbows or Achilles tendons. Though tophi are not painful, they can become swollen and tender during gout attacks.
3. Kidney stones - Urate crystals may deposit in the urinary tract, leading to kidney stones.

What precautions or steps are necessary to stay healthy and happy during the treatment?

For patients who experience many gout attacks in a year, the doctor may recommend certain medications to reduce the frequency of attacks and other gout-related complications. Medications include:

1. Medicines that block uric acid production - Certain drugs limit the amount of uric acid produced by the body, thereby reducing the risk of gout.
2. Medications to facilitate removal of uric acid - Certain drugs improve the kidney's ability to remove uric acid from the body. Lowered levels of uric acid reduce the risk of developing gout attacks. However, this process increases the amount of uric acid in urine and is associated with side effects like stomach pain, rash and kidney stones.

What are the dietary and physical activity requirements during the course of the treatment?

The American Dietetic Association recommends the following during a gout attack:

1. Drinking 8 to 16 cups of fluid every day, with at least half being water
2. Avoiding alcohol
3. Eating a moderate amount of protein, and limiting it to healthy sources like low-fat or fat-free dairy, eggs and nut butters
4. Limiting the daily intake of meat, fish and poultry to 113 to 170 grams

How can the disorder be prevented from happening or recurring?

Changes in lifestyle can help prevent future gout attacks:

• Losing weight
• Exercising daily
• Maintaining healthy diet

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Sources: "Gout," MayoClinic.com, Mayo Clinic Staff, https://www.mayoclinic.org/diseases-conditions/gout/basics/definition/con-20019400 "Gout," MedlinePlus, NLM, NIH, https://www.nlm.nih.gov/medlineplus/ency/article/000422.htm Gout - Topic Overview," WebMD.com, https://www.webmd.com/arthritis/tc/gout-topic-overview