February 07, 2014

Gout

Gout is a disease that results from an overload of uric acid in the body. This overload of uric acid leads to the formation of tiny crystals of urate that deposit in tissues of the body, especially the joints. When crystals form in the joints, it causes recurring attacks of joint inflammation (arthritis). Gout is considered a chronic and progressive disease. Chronic gout can also lead to deposits of hard lumps of uric acid in the tissues, particularly in and around the joints and may cause joint destruction, decreased kidney function, and kidney stones (nephrolithiasis).



 A number of risk factors are related to the development of gout. These include:
  • Obesity
  • High alcohol intake
  •  A genetic predisposition
  • High intake of foods rich in purines (eg: some seafoods and some meat)
  • Certain medicines eg: diuretics (fluid tablets)
  • Injury to a joint
  • Long-standing kidney disease.
 Signs and symptoms
  • Gout develops quickly, often within 12 - 24-hours. Signs and symptoms of a gout attack include:
  • Severe pain and tenderness in the affected joint
  • Swelling of the affected joint
  • The skin over the joint may feel hot and tight and may look shiny and red.
Treatment and diet



  • Medications to reduce pain - particularly non-steroidal anti-inflammatory medications (NSAIDs) such as indomethacin,    naprosyn or diclofenac.
  •  Colchicine - this medication helps to block production of uric acid. It is most effective when taken early in an attack.    However, it can have side effects such as diarrhoea if too much is taken. Dosage instructions should be followed        carefully.
  • Steroids - such as prednisone may be given in tablet form to help reduce pain and inflammation.  Steroid injections    directly into the joint may also be effective.
  • Drinking extra fluid (preferably water) while taking these medications is recommended. The affected joint should also be    rested and elevated.
  • Dietary modifications - are aimed at restricting or avoiding foods high in purines.  Purines are substances found in some foods and produce uric acid when broken down by the body.  Foods high in purines include:
  • Shellfish (pipis, paua, oysters, mussels) and fish roe
  • Offal foods (brains, liver, kidney, tripe)
  • Red meat (beef, pork/bacon, lamb)
  • Yeast extracts (Marmite, Vegemite)
  • Foods containing yeast (bread, beer)
  • Oily fish (sardines, herrings and anchovies).
  • Limiting alcohol intake - is also important.  Alcohol causes the body to lose fluid (by increasing urine output and drawing water from the blood), thus increasing the uric acid concentrations in the blood.  Beer is rich in purines so should be avoided.
  • Drinking plenty of non-alcoholic fluids - eight to 10 glasses a day is recommended.  This will help to flush the uric acid   crystals out of the body.
  • Maintaining a healthy body weight - will help to reduce stress on affected joints and decrease the likelihood of developing gout.
 Sources
Siutherncross, WebMd


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