Gout

Introduction:

Anyone can be affected by Gout, a common and complicated form of arthritis. Pain, swelling, redness, and tenderness in one or more joints most frequently the big toe occur suddenly and intensely.

Gout attacks can come on quickly, often waking you up in the middle of the night with the burning sensation in your big toe. Because of the joint’s heat, swelling, and pain, even the weight of the bedsheets may seem too much to bear.

One of the easiest types of arthritis to treat is Gout, provided it is identified early, treated, and lifestyle modifications are made. Many patients even manage to become gout-free, minimize the severity of their symptoms, and avoid attacks.

There are strategies to control Gout symptoms and avoid attacks, even though they may come and go.

Causes:

Purine absorption results in the production of uric acid by the body. These are compounds found in high levels in a variety of foods and drinks, such as liver, alcohol, and shellfish.

Usually, the kidneys dissolve uric acid in the blood and eliminate it as urine. The body may buildup uric acid and form needle-like crystals if it produces too much of it or does not excrete enough of it. These cause pain and inflammation in the surrounding tissues and joints.

Both hereditary and environmental factors influence how much urate develops in your blood. On the other hand, a number of factors could increase your risk of developing gout;

• Possessing increased urate levels.
• Gout running in the family.
• Going through the menopause.
• Growing older.
• Consuming alcohol.

Sign and symptoms:

Gout symptoms and signs usually appear suddenly and frequently at night.

Among them are;

• Redness as well as inflammation

An enlarged, sore, warm, and red joint or joints result.

• Limited mobility

Joint mobility may become increasingly difficult to regain as gout worsens.

• Severe joint pain

.Though it can affect any joint, gout typically affects the big toe. The elbows, wrists, fingers, ankles, and knees are among the other joints that are frequently affected. In the first four to twelve hours after it starts, the pain is probably at its worst.

• Persistent pain

For a few days to a few weeks following the resolution of the most severe pain, some joint soreness may stay. Later attacks might impact more joints and last longer.

Who has the highest risk of developing Gout?

Gout affects a lot of people. More men than women have it. The onset of gout usually occurs in middle age. Gout affects women later in life than it does men because it rarely impacts them before menopause. Although younger people have a lower risk of contracting the disease, the illness is more severe when it does.

• Have a male gender.
• Are older, usually appearing in middle age.
• It happens to be obese.
• Elevated Blood Pressure
• The metabolic syndrome
• Prolonged Diabetic Nephropathy
• Diseases like psoriasis or multiple cancers that increase the breakdown of your cells.

What foods are Gout causing?

Consuming or drinking foods high in purines, such as those listed below, raises uric acid levels in the body and raises the risk of gout;

• Alcohol: Although not all alcoholic beverages contain a lot of purines, alcohol keeps uric acid from being removed by your kidneys, making it stay in your body and build up.

• Sugar-filled beverages and desserts: Half of regular table sugar is fructose, or fruit sugar, which metabolizes to uric acid. Any high-sugar food or beverage has the potential to cause gout.

• Some seafood options include fish, codfish, sardines, scallops, oysters, and fish like trout.

Diagnosis:

It can be difficult to tell the difference between an acute attack of gout and an infection or other medical condition at times. Your doctor may use certain tests to help in the diagnosis process.

• Blood test

The amount of uric acid in your blood can be identified via a blood test. Gout is strongly suggested by a high uric acid level. Additionally, your physician will examine blood markers for infection, which are frequently elevated (high) during a gout attack.

Your uric acid levels may occasionally test normal as in an acute gout attack, uric acid might leave the circulatory system and enter the tissue that is inflammation. In case you experience a gout attack and have elevated uric acid levels, it is likely that your pre-attack level was also elevated. If your blood uric acid levels are high between attacks, your doctor may use this information to help confirm gout.

Gout sufferers may have varying blood levels of uric acid at different times, and the majority of people with hyperuricemia never get the disease.

• Analysis of Synovial Fluid

Your doctor might suggest a synovial fluid analysis if your symptoms don’t go better after trying some initial treatments. For gout, this test offers better results.

Your inflammatory joint’s synovial fluid is taken out for this test. Joint synovial fluid surrounds and lubricates joints. White blood cells are present in the increased fluid in the joint caused with gout. Additionally, crystals of uric acid that require a special microscope will be present. In addition, the synovial fluid is examined for bacterial infections, which may occasionally occur with gout.

Differential Diagnosis:

Doctors take into account a variety of potential illnesses that could manifest with similar symptoms when diagnosing gout. To guarantee the right course of treatment, it’s essential to separate gout from other illnesses. Several primary conditions can be taken seriously when making a differential diagnosis for gout.

 These include;

• Rheumatoid arthritis

An autoimmune condition called rheumatoid arthritis (RA) mostly affects the joints, causing ongoing pain, inflammation, and deformity. RA frequently affects multiple joints symmetrically, whereas gout usually affects one joint at a time. Anti-cyclic citrullinated peptide (anti-CCP) antibody tests and rheumatoid factor (RF) tests are two blood tests that can be utilized to separate gout from rheumatoid arthritis.

• Osteoarthritis

Degenerative joint disease called osteoarthritis is characterized by the degradation of joint cartilage. It may produce symptoms similar to gout, such as stiffness, swelling, and pain in the joints. Imaging tests, such as X-rays, can be used to diagnose joint damage and differentiate gout from osteoarthritis.

• Cellulitis

Bacterial skin infections, such as cellulitis, can cause pain, warmth, swelling, and redness in the affected area. Sometimes, the same areas that experience attack of gout also experience cellulitis, such as the foot or lower leg. Fever, skin alterations, and progressive redness can be used to separate between gout and cellulitis.

Treatment:

Nonsurgical Treatment:

Medication designed to lower blood uric acid levels may be helpful for patients whose levels of uric acid remain elevated.

NSAIDs are commonly used to treat Gout attacks because they can lessen inflammation and ease pain.

Physicians most frequently give patients long-term prescription medicines if they have;

• Over three periods of gout per year
• Gout attacks that are so severe they affect
• Clearly visible gouty joint arthritis that may worsen over time
• Tophi Kidney damage, recurrent kidney stones, or high uric acid removal in their urine
• The uses of the available medications vary. In the event that gout is diagnosed in you, your primary care physician will talk about the best course of treatment.

Medications for gout pain relief include;

• Non-steroidal anti-inflammatory substances (NSAIDs) include aspirin, Aleve, and Ibuprofen (Advil, Motrin).
• Colchicine
• Corticosteroids

Your physician may prescribe medication in alongside lifestyle modifications to improve symptom management and lower your chance of experiencing another gout attack.

Changes in lifestyle:

You can take steps to avoid gout attacks and further joint damage in addition to following to your doctor’s treatment plan.

• To keep your weight at a healthy level, exercise and pay attention to your diet.
• Drink plenty of water to help your body in eliminating uric acid.
• Lower your calorie intake, especially that of fat calories.
• Do not add sugar to bitter beverages or consume sugar-filled drinks.
• Lean on low-fat dairy products to get your protein instead of meat and shellfish. Because meat and seafood are high in purines, some people may experience elevated uric acid levels from eating too much of them.
• Avoid  alcohol.

Physiotherapy treatment:

During acute episodes of the management program, the physiotherapist’s primary focus should be on using splinting, orthotics, or other assistive devices to protect the affected joint or joints.

Physiotherapy is a useful treatment for gout, an inflammatory form of arthritis caused on by high blood uric acid levels. Physiotherapy is typically used to treat pain and protect the joints during an acute episode of gout, which can result in sudden, severe pain, inflammation, and redness in the joints. After the attack is over, physiotherapy can help restore joint function, strength, and mobility to prevent future episodes from occurring.

Based on your unique needs, the physiotherapist will design a treatment plan that may include;

• Exercises: Do range-of-motion, stretching, and strengthening exercises to improve joint strength, flexibility, and mobility.

• Modalities: You can use heat, ice, ultrasound, or electrical stimulation to help lessen pain and swelling.

• Activities to improve balance and coordination: By improving these skills, you can prevent falls.

Gout surgery:

Gout is typically treatable without surgery. However, over time, this illness may cause infections in the skin surrounding the joints, break tendons, and harm the joints themselves.

Tophi, or hard deposits, may develop in your joints and other areas such as your ear. These lumps can cause permanent joint damage and may be painful and swollen.

Tophi is treated surgically with three methods;

• Surgery to remove tophi
• Surgery for joint fusion
• Surgery for a replacement joint

Depending on the location of the tophi, the degree of damage, and what you want, your doctor might suggest one of these surgeries.

Risk-related factor:

If your body has high levels of uric acid, you have a higher chance of developing Gout.

The following are some factors that raise your body’s uric acid level;

• Both gender and age

Men are more likely than women to develop Gout, mainly because women typically have lower uric acid levels. But after menopause, women’s uric acid levels start to rise similarly to men’s. In addition, men are more likely than women to develop gout symptoms and signs earlier in life, typically between the ages of 30 and 50.

• Recently had trauma or surgery

An attack of Gout can occasionally be put on by trauma or recent surgery. Vaccinations may cause gout episodes in certain individuals.

• Weight

Being overweight causes your body to produce more uric acid and makes it harder for your kidneys to remove it from your body.

• Health issues

Your risk of getting gout is increased by several conditions. These include uncontrolled hypertension and long-term illnesses like diabetes, obesity, metabolic syndrome, and diseases of the heart and kidneys.

• Gout in the family history

You are more likely to get gout if other family members have had the condition.

Complications:

Gout sufferers may experience more severe symptoms like;

• Kidney stones

For those who have gout, kidney stones can develop from uric acid crystals building up in their urinary tracts. Kidney stones can be partially prevented with medication.

• Persistent gout

Some people might never again have the symptoms and signs of gout. Some people might get gout multiple times a year. For those with recurrent gout, medication may help avoid gout attacks. Gout has the potential to degrade and destroy a joint if left untreated.

• Gout in its advanced stages

Tophi are nodules under the skin that may develop urate crystal deposits if gout is not treated. There are various places where tophi can appear, including the tendons that run along the backs of your ankles, your hands, elbows, feet, and fingers. While tender and swollen during gout attacks, tophi are usually not painful.

Gout prevention:

The following actions may help in preventing gout;

• Restrict your alcohol intake.
• Eat fewer foods high in purines, such as organ meat, lamb, beef, and pork, and shellfish.
• Have a vegetarian, low-fat, and high-vegetable diet.
• Keep a healthy weight.
• Stay out of smoking.
• Engage in regular exercise.
• Remain hydrated.
• See your doctor about ways to reduce the risk of gout attacks if you take medications or have medical conditions that increase your risk of gout.

Summary:

One prevalent kind of arthritis is gout. It may result in excruciating pain, edema, and stiffness in and around specific joints.

In order to treat gout, a doctor will usually prescribe medicines that lower inflammation and help control uric acid levels. Self-care techniques, such as minimizing alcohol and purine-rich foods and maintaining adequate hydration, are also beneficial. To help avoid flare-ups, your doctor or nutritionist may also suggest dietary adjustments. You can effectively manage your gout by maintaining a healthy lifestyle and eating a balanced diet.

FAQ:

References:

• Mayo Clinic: Gout: Symptoms and Causes (2022, November 16). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897#:~:text=Gout%20occurs%20when%20urate%20crystals,found%20naturally%20in%20your%20body.

• S. Montoya (2024b, 16 February). foods to consume and foods to avoid when having gout. Foods to Eat: https://www.medicalnewstoday.com/articles/315732

• March 8, 2023; Kin man, T. Gout: Signs, Causes, and Management. The website Healthline provides information on gout.

• Ortho Info – AAOS – Gout Causes and Treatments (n.d.-b). Gout can be found at https://orthoinfo.aaos.org/en/diseases-conditions

• On February 10, 2024, Tadvi, D. All You Need to Know About Gout. Treatment and exercise in physical therapy. gout.physical-therapy.us/