Today we're going to talk about Gout. What is gout? Causes, symptoms, and treatment of gout.
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Gout is a very common form of inflammatory arthritis that can result in painful swollen joints involving usually one to two joints of the lower limb each time due to deposition of uric acid crystals into the affected joint.
It most commonly affects the big toe and large joints in our lower limbs like the ankle or knee.
Now we can’t talk about gout without first discussing purine and uric acid.
Purines are molecules made up of carbon and nitrogen atoms and these molecules are found in a cell’s DNA and RNA.
2/3 of purine in our body is due to the natural death and breakdown of our body cells while the other 1/3 are from our diet. Food high in purine contents include:
red meat, animal innards like liver, seafood: anchovies, sardines, mussels, scallops, tuna, alcoholic beverages especially beer, food and drinks sweetened with fruit sugar ( fructose )
Purines have to be broken down in our body into uric acid to be removed through our kidneys and liver ( through urine and feces)
Gout occurs when uric acid crystals accumulate in your joint, causing inflammation and intense pain. Uric acid crystals can form when you have high levels of uric acid in your blood due to high levels of cell breakdown or when there is excess ingestion of purine-containing food.
Initially, gout attacks usually affect one joint with complete resolution of symptoms between attacks but at the later stages, gout attacks can affect multiple joints including those of the upper limbs with the frequency of attacks increasing.
Men are at a higher risk than females, Age: gout tends to happen to adults in their 30s with the risk increasing with age. Patients who are obese with metabolic syndrome. Family history, Diet high in purine. Patients who are on a certain type of medications such as aspirin, hypertension medications like diuretics, ACE inhibitor and beta-blockers
Gout can be diagnosed through a combination of typical symptoms, lab tests including blood test and joint fluid analysis, and typical x-ray findings.
symptoms wise, patients often develop one or two joint pain and redness and swelling usually involving the lower limbs.The most common joint to be involved in the metatarsal-phalangeal joint of the big toe.They often describe the pain to be of rapid onset ( within a day or two ), intense pain that affects their walking.This joint pain comes and go, in fact, some of my patients even tell me that they can anticipate the onset of arthritis just by the feeling of impending joint inflammation.
Of course in chronic patients, some of them develop tophis - these are chalky deposits of urate crystals in the skin.
Typical X-ray findings of the affected joint includes
- subcortical cysts without erosions
- punched out or rat has bitten erosion of bones
If we can draw out the fluid within the swollen joint and send for microscopy and analysis, then the diagnosis can be achieved by
- visualizing the uric acid crystals through polarised light microscopy
- and not seeing any bacteria within the fluid to indicate an infective cause for the swelling.
Having an elevated blood level of uric acid level can also be helpful for diagnosis.
however, there are also many patients who are suffering from gouty arthritis with normal uric acid levels.Once a diagnosis has been achieved, we can then treat the patient
In the acute stage when the patient is suffering from pain,
Treatment of arthritis involves rest- adequate hydration
- anti-inflammatory medications like NSAIDs and COX-II inhibitors, sometimes steroids
and colchicine
Dietary changes :
Reduce intake of purine-rich animal protein like beef, lamb, pork, and innards
Reduce intake of shellfish, tuna, sardines, anchovies
Reduce intake of alcohol especially beer
Reduce intake of fructose-sweetened food and beverages
take more plain water. Unsweetened coffee and tea can be taken as well.
Take more fruits and vegetables - these do not cause gout.
Low fat or no-fat dairy products are suitable too.
2) Getting physically active and losing weight.
These can help with obesity - which is a risk factor for gout.Exercise and losing weight can help reduce the inflammatory state of the body and helps in building strong joints as well.
3) Medications.
Medications like allopurinol and febuxostat can help in reducing the levels and therefore help in reducing the frequency of the attacks.
0:00 intro
0:27 what is gout
1:43 What causes gout
2:17 risk factors for gout
2:49 diagnostic criteria for gout
4:19 treatment for gout
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