Managing a Gout attack
Gout is characterized by sudden, severe attacks of pain, redness and tenderness in joints, often the joint at the base of the big toe.
Gout, a complex form of arthritis, can affect anyone. Men are more likely to get gout, but women become increasingly susceptible to gout after menopause.
An attack of gout can occur suddenly, often waking you up in the middle of the night with the sensation that your big toe is on fire. The affected joint is hot, swollen and so tender that even the weight of the sheet on it may seem intolerable.
Fortunately, gout is treatable, and there are ways to reduce the risk that gout will recur.
Symptoms of Gout
Severe pain in the joints, steadily goes away, itchy and peeling skin later, inflammation and irritation, red and purplish skin, fever, limited movement or less flexibility, nodules in elbows, and hands or ears.
Causes of Gout
Gout occurs when urate crystals accumulate in joint, causing the inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood. Body produces uric acid when it breaks down purines --- substances that are found naturally in body, as well as in certain foods, such as steak, organ meats and seafood. Other foods also promote higher levels of uric acid, such as alcoholic beverages, especially beer, and drinks sweetened with fruit sugar (fructose).
Normally, uric acid dissolves in blood and passes through kidneys into urine. But sometimes body either produces too much uric acid or kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needle-like urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.
Risk factors of Gout
You're more likely to develop gout if you have high levels of uric acid in your body. Factors that increase the uric acid level in your body include:
Diet: Eating a diet that's high in meat and seafood and high in beverages sweetened with fruit sugar (fructose) promotes higher levels of uric acid, which increases risk of gout. Alcohol consumption, especially of beer, also increases the risk of gout.
Obesity: If you are overweight, your body produces more uric acid and your kidneys have a more difficult time eliminating uric acid, which greatly increases risk of gout.
Medical conditions: Certain diseases and conditions make it more likely to develop gout. These include untreated high blood pressure and chronic conditions such as diabetes, metabolic syndrome, and heart and kidney diseases.
Certain medications: The use of thiazide diuretics - commonly used to treat hypertension - and low-dose aspirin also can increase uric acid levels.
Family history of gout: If other members of your family have had gout, you're more likely to develop the disease.
Age and sex: Gout occurs more often in men, primarily because women tend to have lower uric acid levels. After menopause, however, women's uric acid levels approach those of men. Men also are more likely to develop gout earlier - usually between the ages of 30 and 50 - whereas women generally develop signs and symptoms after menopause.
Recent surgery or trauma: Experiencing recent surgery or trauma has been associated with an increased risk of developing gout.
Complications of Gout
Persistent gout, advanced gout, kidney stones, Gout might spread, and hurt to joints.
Diagnosis of Gout
Tests to help diagnose gout may include:
Joint fluid test: Fluid from your affected joint when examined under the microscope, your joint fluid may reveal urate crystals.
Blood test: To measure the levels of uric acid and creatinine in blood. Blood test results can be misleading, though. Some people have high uric acid levels, but never experience gout. And some people have signs and symptoms of gout, but don't have unusual levels of uric acid in their blood.
X-ray imaging: Joint X-rays can be helpful to rule out other causes of joint inflammation.
Ultrasound: Musculoskeletal ultrasound can detect urate crystals in a joint or in a tophus.
Treatments and drugs
Treatment for gout usually involves medications. What medications you and your doctor choose will be based on your current health and your own preferences. Gout medications can be used to treat acute attacks and prevent future attacks as well as reduce your risk of complications from gout, such as the development of tophi from urate crystal deposits.
Drugs used to treat acute attacks and prevent future attacks include:
Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs include over-the-counter options such as ibuprofen) and naproxen sodium as well as more-powerful prescription NSAIDs such as indomethacin or celecoxib. Your doctor may prescribe a higher dose to stop an acute attack, followed by a lower daily dose to prevent future attacks.
Colchicine: Your doctor may recommend colchicine a type of pain reliever that effectively reduces gout pain. The drug's effectiveness is offset in most cases, however, by intolerable side effects, such as nausea, vomiting and diarrhea. After an acute gout attack resolves, your doctor may prescribe a low daily dose of colchicine to prevent future attacks.
Corticosteroids: Corticosteroid medications, such as the drug prednisone, may control gout inflammation and pain. Corticosteroids may be administered in pill form, or they can be injected into your joint. Corticosteroids are generally reserved for people who can't take either NSAIDs or colchicine.
Medications to prevent gout complications
If you experience several gout attacks each year or if your gout attacks are less frequent but particularly painful, your doctor may recommend medication to reduce your risk of gout-related complications.
Medications that block uric acid production: Drugs called xanthine oxidase inhibitors, including allopurinol and febuxostat, limit the amount of uric acid your body makes.
Medication that improves uric acid removal: Probenecid, improves your kidneys' ability to remove uric acid from your body. This may lower your uric acid levels and reduce your risk of gout, but the level of uric acid in your urine is increased. Side effects include a rash, stomach pain and kidney stones.
Precautions and preventions of Gout
Avoid heavy alcohol consumption such as beer, maintain a desirable body weight, avoid to regular use of aspirin and niacin, avoid use of diuretic medicine, limit your intake of meat, fish and poultry, get your protein from low-fat dairy products, and keep your fluid intake high.
How to handle Gout attack
Few things in life are more painful than a gout attack, so if you're awakened in the wee hours by a joint that is tender, swollen, red and radiating heat, you'll want to act fast. Here's what you can do when a gout attack starts to ease the pain of the attack and reduce the risk of others.
Take medicine you have on hand: Start treatment immediately with over-the-counter ibuprofen or naproxen, but never take aspirin, which can actually worsen an attack. If you are already taking a uric acid-lowering drug to reduce the risk of attacks, and continue to take that drug through this attack.
Ice down: Applying an ice pack to the painful joint may help ease pain and inflammation. Wrap a pack (a bag of crushed ice or frozen peas will also do) in a dish cloth and apply to the area for 20 to 30 minutes at a stretch several times a day.
Call your doctor: Let your doctor know what is going on right away. He or She may prescribe a new medication or have you come to the office for a joint fluid test (to confirm the gout diagnosis) or an injection of a corticosteroid to start relieving inflammation quickly. Getting treatment within the first 24 hours of the start of an attack can lessen its length and severity.
Drink plenty of fluids: Staying hydrated helps flush out uric acid and prevent kidney stones, another possible problem associated with high uric acid levels. Aim for eight to 16 cups of fluids a day, at least half of them water. Avoid alcohol.
Elevate your foot, if affected: Raising your foot with pillows so it's higher than your chest may help lessen swelling.
Tame your sheets: Even the weight of your bed sheets can be unbearable to an inflamed, gouty toe. Tuck the sheet in on the sides so its end falls at calf level, leaving your painful toe free.
Create gout-friendly socks: Cut the big toe out of cheap socks or cut the toe section off completely so you can have warm feet without toe pain.
Chill out: Try to relax if you can; stress can aggravate gout. Watch a movie, talk to a friend, read a book or listen to music
Revamp the menu: Stop eating troublesome high-purine foods, such as shellfish, red meat, sweetbreads and gravies.
The writer is a resident physician, Department of Medicine, MARKS Medical College & Hospital