A Family Doctor's Tale - GOUT

DOC I HAVE GOUT

Gouty arthritis patients are non uncommon. 
You can see them limp into your clinic with a painful big toe or swollen ankle or knee. 
One of my patient comes to the clinic every time he took alcohol the night before.
Another comes after eating too much peanuts while watching TV the night before. 
Another comes after  binging on seafood - prawns, lobsters, crabs. The most common location is the big toe. 
After one injection and some medicines they become better and swear off the above food until the next occasion. 
The best prevention is to avoid the food and take the allopurinol for prevention and lots of water to dilute the uric acid.

Gout is a disease caused by the excessive uric acid in the blood.


Gout is often hereditary so even young adults are affected.
It occurs more commonly in men than in women.


The uric acid in the blood is usually discharged from the body dissolved in the urine and the intestinal tract and sometimes as perspiration through the skin.


1. Gouty Arthritis
high concentration of uric acid in the blood caused the formation of needle shaped urate crystals which are deposited in and around joints thus causing pain and swelling.


2.Kidney stones
Deposits can also form in the kidney and urinary tract as urate crystals or stones.


3.Skin urate trophi
Some urate crystals are also deposited in the skin, mostly commonly at the earlobe and joints.


The symptoms of gouty arthritis are usually of sudden onset.
They are:
1.pain
2.swelling
3.pain
4.joint feels hot


These are the most common joints affected by Gout:


1. Big toe 76%
2. Ankle 50%
3. Knee 32%
4. Fingers 25%
5.Elbow 10%
6. Other Joints 2%


1.Drinks lots of fluids(at least 8 glasses of water a day).
This will help to excrete the uric acid through the urine and dilute the uric acid
concentration in the blood.


2.Avoid food which can produce high levels of uric acid. These are high protein foods such as:
Animal organs -liver,kidneys, intestines,brain
Seafood - especially prawns, crab meat, lobsters, cockleshells, fish roes
Bean products- bean curds, soya beans,bean sprouts, peanuts
Alcohol - cause dehydration in the blood raising the concentration of uric acid.


3.Avoid fasting and starvation - again this raises the concentration of uric acid in the blood.

Obesity should be slowly reduced. The over-weight body affects the joints.


4.Avoid certain drugs like diuretic which reduces the volume of water in the blood and
raises the concentration of uric acid.


5.Take medications like allopurinol which help to reduce the production of uric acid.
--
1.Take medicine like probenecid or cochicine which helps to flush the uric acid out through the urinary tract.


2.Drinks lots of water (eg. 3 glasses of water) immediately during an acute attack.


3.Rest the joint. If the the big toe is affected, raise it above the heart level to help the blood flow.


Complications of gout are:

1.Kidney stones may develop in the kidneys or urinary tract causing pain and damage to the kidneys.
2.Recurrent attacks of gout may erode the surfaces of the joint resulting in permanent damage.