Gout Overview

Gout is an inflammatory disease which is characterized mainly by the disturbance in the metabolism of uric acid in the body. The disease arises due to two conditions, either there is a surge in the production of uric acid or there is some fault in the removal system of the body. Generally, the elevated quantity of the uric acid tends to get stored in the joints of the body, particularly the metatarsal phalangeal joint of the big toe, which is also the primary site of gout attack. With the advent of the disease, additional joints get affected resulting in pain, tenderness and inflammation. A surge in the number of people affected by gout has been noticed in the recent years. Faulty lifestyle habits, like over consumption of alcohol and high purine intake, are considered to be the main contributing factors. The disease is manageable with modern medications and by incorporating desired changes in the lifestyle.

Hyperuricemia is the basic cause of gout. The various factors causing this condition are genetic predisposition, a diet rich in proteins (specifically red meat), sea food, alcohol, overuse of diuretics, niacin, aspirin, cyclosporine, and several medical conditions like obesity, kidney disease, diabetes, leukemia etc.

The main symptom is mostly acute pain which is excruciating in nature and is felt at night, primarily in the metatarsal phalangeal joint of the big toe which may last for 2-4 hours. Gradually, as the disease progress with time, other joints of the body are also affected viz. knee joint, elbow joints, wrists and fingers. The span and intensity increases as the disease progresses. But, generally after an attack, there are no intermittent symptoms evident between two attacks. The individuals who develop a chronic case history of gout, suffer from joint deformation and loss of motion of the joint. The crystals of uric acid start to deposit as ‘tophi’ in the available joint space. The chronic condition may lead to the erosion of bone tissue due to extensive tophi formation.

Synovial fluid analysis depicting the crystals of monosodium urate monohydrate is a confirmation test. Other examinations which are carried out in support are blood test for WBC count, electrolytes, renal function and ESR. Although, no significant changes are noticed in acute cases in radiographs, but chronic cases may show joint deformity with the soft tissue swelling of urate tophi.

To relieve an acute attack, NSAIDs are the agents of choice. Indomethacin or naproxen is prescribed during an acute attack. Colchicine is also an effective agent. Allopurinol is the drug of choice in chronic cases as a long term prophylaxis. Uricosuric agents like probencid are also very effective in certain patients. Benzbromaxone is administered in patients showing moderate renal impairment.

An acute attack can be effectively treated with medications. But, if ignored then the condition progresses towards the chronic gouty arthritis which may eventually lead to joint deformity and painless tophi formation. Other medical ailments that may arise are kidney stones, chronic renal dysfunction, hypertension, diabetes etc. There can be certain side effects with some medications, like NSAIDs, and are always prescribed with caution as certain individuals are sensitive to their use. Dosage of allopurinol must be properly administered. Colchicine may show gastrointestinal disturbance as a probable side effect in some patients. Lowering down purine intake and alcohol consumption are the main preventive measures. Severe dietary restrictions are to be avoided. But a gradual weight loss is always encouraged.