Gout Causes and Treatment
Gout has the very obvious symptoms of a very red, swollen and excruciatingly painful joint. The most common joint to be involved is the ball of the foot, but almost any joint in the body may be involved. In severe attacks, a fever may develop, along with a rapid heart rate, loss of appetite and flaking of skin over the affected joint. Victims describe the exquisite pain of gout as having a joint full of barbed wire, with the wire being constantly twisted and turned so that it stabs repeatedly. The attacks start very suddenly, often at night, and may occur every week or so, or only once in a lifetime. The tendency to develop the disease runs in families, so that if your father had gout, your chances of developing the disease are above average. Nearly all gout victims are men and it usually starts between 30 and 50 years of age.
Gout is caused by excess blood levels of uric acid, which is produced as a normal breakdown product of certain foods. Normally it is removed by the kidneys, but if excess is produced or the kidneys fail to work efficiently, excess levels build up in the body. The excess acid can precipitate as crystals in the cavity of a joint. Under a microscope the crystals look like fine needles, and this is why they cause severe pain in the patient who has millions of these tiny crystals jabbing into the lining of his joint. The acid crystals can also form lumps (called tophi) under the skin around joints and in the ear lobes, but this disfiguring complication is rare with modern treatment. More seriously, the crystals may damage the kidneys and form kidney stones. Patients may have high levels of uric acid (hyperuricaemia) in their bloodstream, which may be causing kidney damage but not painful joints. The only way to detect this situation is with a blood test. Once detected, treatment is just as important as in gouty arthritis in order to stop the formation of kidney stones and to protect the kidneys from irreparable damage.
Gout is traditionally said to be caused by high living and drinking alcohol. This is not strictly true, but a drinking binge or eating a lot of meat can start an attack in someone who is susceptible to the disease. Sufferers should avoid foods that contain high levels of purine, which metabolizes to uric acid. These include prawns, shellfish, liver, sardines, meat concentrates and game birds.
The treatment of gout takes two forms: 1) treatment of the acute attack, and 2) prevention of any further attacks.
Doctors will prescribe a combination of anti-inflammatory drugs and a medication called colchicine that will relieve the acute attack rapidly. Rest of the affected joint to control the pain and prevent further joint damage is also important. After blood tests to confirm the disease and exclude any complications, the patient must start taking one or more tablets a day for the rest of his life to prevent the pain and kidney damage of further attacks.
Patients can help themselves by avoiding the foods listed above, not consuming excess alcohol, keeping their weight under control, drinking plenty of liquids to prevent dehydration, avoiding overexposure to cold, not exercising to extremes and remembering to take the gout- preventing tablets. If the tablets are missed, an attack of gout can follow very quickly.
Gout was dreaded a century ago because of the pain and crippling it caused, but doctors can control and prevent it quite easily these days, provided the patient understands the problem and cooperates with the treatment program.
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