Gout : A Particular Form Of Arthritis, Here We Could Find The Best Treatments
Thursday, November 24,2016
Gout is a particular form of arthritis that causes recurrent attacks of severe pain at one or more joints. Usually, gout attacks last a few days, then the symptoms disappear for several weeks.
All joints are likely to be affected, but most often the disease develops first in the one at the base of the big toe. The joint then becomes purplish red and swollen.
An abnormally high level of uric acid in the blood, a condition called hyperuricemia, is causing gout. Uric acid is one of the waste that the body’s metabolism normally produces (see Causes, further on).
When there is a surplus, uric acid is gradually deposited in the body in the form of crystals, among others in the joints. These deposits trigger inflammatory reactions.
Gout affects close to 2% of adults, especially men. The first crisis normally occurs around the age of 30 to 45 years for men, and after menopause for women.
Here is what happens in the body of an affected person. Uric acid is, in a way, a waste that the body must eliminate. It is the final product of purine degradation. About two thirds of the purines to be eliminated each day come from the dead cells of the body, and one third of the ingested food. Red meat, and seafood, for example, are very rich in purines.
It is normal that a certain amount of uric acid is circulating in the blood. However, if uric acid is present in too great a quantity and the kidneys do not succeed in eliminating this excess, its blood concentration increases. The body is then hyperuricemic.
Over the years, excess uric acid is deposited in the tissues in the form of crystals of sodium urate. The deposits form in the joints or elsewhere in the body (under the skin, in the cartilages, in the kidneys, etc.).
The white blood cells then try to get rid of them by “eating” them by phagocytosis. As a result, the crystals damage the white blood cells, which triggers a violent inflammation that lasts up to 2 weeks, if left untreated.
For reasons unknown, hyperuricemia does not always cause symptoms. In fact, only one-third of people with hyperuricemia have gout. It is estimated that between 5% and 10% of the adult population is hyperuricemic.
Evolution of the gout
Since gout is better known today and there are several ways of controlling it, the quality of life of those suffering from it has improved greatly. Early diagnosis and treatment can reduce the number of seizures and prevent permanent damage to the joints.
In the absence of treatment, the first crisis disappears spontaneously in 1 to 2 weeks. During the first 24 to 36 hours, the pains are intense. The slightest pressure on the joint is unbearable, and it may even be impossible to put on a stocking. On the other hand, if the crisis is treated quickly, it lasts from 1 to 2 days. Often, a new crisis is triggered from 6 months to 2 years later. Only a small proportion of affected people will have only one attack of gout in their lifetime.
This is rare today, but if gout is not treated adequately, the frequency of seizures and the number of affected joints tends to increase over time. Arthritis can then become chronic in several joints (knees, ankles, wrists, elbows, etc.).
Crystal deposits can be created under the skin: they are called tophi (or tophus, in the singular). They appear on the outer edge of the ear, on the elbows, on the fingers, on the toes and near the Achilles tendon. They can damage the tendons.
In case of treatment neglect, excess uric acid can also be deposited in the kidneys, block its normal channels and cause kidney stones or kidney failure.
As the case may be, the physician will use one or the other of the following types of specimen.
- Blood test: measure of the level of uric acid in the blood (uricemia).
- Urine sample: evaluation of the amount of uric acid excreted by the kidneys.
- Puncture of synovial fluid of affected joint: search for crystals of uric acid, to confirm the diagnosis. Uric acid crystals are not detectable by radiological examinations (X-rays or the like), but are visible under a microscope in a synovial fluid sample.
Symptoms, people at risk and risk factors for gout
A sudden, intense and pulsating pain in a joint. Crises occur mostly at night. The joints at the extremities of the limbs are more sensitive than the others, in particular because they are colder. Cold may cause the transformation of liquid uric acid into uric acid crystals.
Swelling and redness of affected area.
A great cold sensation at the affected joint.
Rarely, generalized joint pain, accompanied by general malaise, fever (up to 39 ° C) and chills. In this case, report to the hospital as a matter of urgency.
People at Risk
Men, probably because from puberty, their blood uric acid level is naturally higher than that of women.
On the other hand, at menopause, women have a similar level of uric acid as men, and the gender gap narrows. Before menopause, estrogen hormones activate the removal of uric acid by the kidneys.
Individuals with any of the following health problems:
- kidney disease (kidney stones, kidney failure);
- the metabolic syndrome;
- narrowing of the opening of the arteries (atherosclerosis).
People who take certain medications, such as diuretics and aspirin taken regularly at low doses.
People who have a family history of gout. A hereditary metabolic problem could lead to excessive production of uric acid in the body.
Here are some factors that contribute to increasing uric acid production or decreasing its excretion:
Excess food, especially protein derived from offal, white and red meat, fish and seafood.
Similarly, a caloric intake that consistently exceeds the body’s needs increases the blood level of uric acid.
Alcohol abuse: half the people who suffer from gout would have bad habits of alcohol consumption. Ethanol increases the production of uric acid (without having any effect on its excretion). Beer is the alcoholic drink that raises uric acid the most.
Stress: It depletes the antioxidant substances of the body. Free radicals then attack the cells more and precipitate cell death (leading to the formation of uric acid).
Prevention of gout
Measures to reduce the risk of recurrence and complications
In the past, monitoring diet was the primary means of treating gout. Nowadays, as some drugs reduce the concentration of uric acid in the blood, doctors no longer necessarily restrict their patients to a strict diet.
However, foods rich in purines raise blood uric acid levels, and some should be banned during a gout attack (see Medical Treatments section).
Here are the recommendations of the Professional Order of Dietitians of Quebec in terms of diet, which it is advisable to follow between crises or in case of chronic gout.
Adjust the energy intake according to your needs. If weight loss is indicated, ensure that it occurs slowly and gradually. A rapid weight loss (or fasting) reduces the excretion of uric acid by the kidneys.
Properly divide your intake of protein, fat and carbohydrate.
Have a sufficient intake of fruits and vegetables, which have a protective effect against gout (8 to 10 servings per day for men, and 7 to 8 servings per day for women).
Avoid or limit the ingestion of alcohol. Drink at most 1 drink per day, and no more than 3 times a week.
Note. Recommendations vary from one source to another. Some suggest reducing consumption of beer and spirits (e.g, vodka) . Drinking wine moderately (up to 1 or 2 glasses of 5 oz or 150 ml per day) would not increase the risk of gout. The amount of alcohol well tolerated by people with gout can vary.
Drink at least 2 liters of water or drinks (soups, juice, tea, etc.) per day. Water is to be preferred.
What about coffee?
Coffee is not to be avoided in case of gout, because it contains negligible amounts of purines. According to epidemiological studies, it appears that the regular consumption of coffee would even have a slight protective effect against this disease.
A diet rich in vitamin C: beneficial?
The link between dietary intake of vitamin C and uric acid in the blood was studied in a group of 1,387 men under the Health Professional Follow-up Study. The higher the intake of vitamin C, the lower the level of uric acid. However, this finding will have to be verified by other studies.
Warning. Ketogenic diets are not recommended for people with gout. This type of diet is particularly low in carbohydrates and high in fat. Ketogenic diets reduce the excretion of uric acid by the kidneys. This is the case of the Atkins diet, for example.
Medical treatments for gout
There is no curative treatment for gout at this time. The therapeutic approach acts on two levels. it aims :
To relieve the symptoms (pain and inflammation) of an acute crisis and to interrupt the crisis thanks to anti-inflammatory agents;
To prevent recurrences and complications, in the long term, with drugs lowering the level of uric acid blood.
Medications for Pain Relief and Inflammation
In the event of a seizure, nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed, such as ibuprofen (Advil®, Motrin®) or naproxen (Naprosyn®, Aleve®, Anaprox®). These act quickly.
If non-steroidal anti-inflammatory drugs are ineffective, oral treatment with Colchicine (Colchimax®) may help. This medicine has an anti-inflammatory and pain-killing effect. It was the first to be used to relieve gout. Taken for a long time, it also reduces the frequency of seizures.
On the other hand, it does not prevent the formation of crystals of uric acid in the joints. The majority of users have nausea, vomiting, diarrhea and abdominal cramps. These important side effects explain why colchicine is no longer the first drug proposed to relieve pain.
If the patient is not relieved by previous treatments, steroidal anti-inflammatory drugs, or corticosteroids, may be prescribed (eg prednisone). They are taken either orally, in tablets, or by injection into the diseased joint.
Warning. Aspirin, a popular anti-inflammatory, is contraindicated in cases of gout, as it raises the level of uric acid.
Drugs to prevent recurrences and complications
Medication is used to lower uric acid levels to prevent seizures and reduce the risk of kidney problems and permanent joint damage. It works in two ways and gives interesting results.
Increase the excretion of uric acid. Some drugs act on the kidneys so that the body removes more uric acid. In addition to decreasing the level of uric acid in the blood, they prevent the deposition of crystals in the joints. The most effective drug is probenecid (Benemide in France, Benuryl in Canada). It is contraindicated in patients with renal insufficiency or kidney stones.
Decrease the production of uric acid. Allopurinol (Zyloric® in France, Zyloprim® in Canada) effectively limits joint damage that can occur in the long term.
A significant decrease in uric acid was observed 24 hours after the start of treatment. It continues and reaches a satisfactory level after 2 weeks of treatment. Allopurinol works by inhibiting an enzyme that participates in the synthesis of uric acid.
Caution. Do not begin treatment with allopurinol before the complete end of an acute gout attack. Otherwise, the crisis may re-emerge.
Food during a crisis
Here are a few tips :
Avoid alcohol or limit yourself to 1 glass in a day, and do not exceed 3 drinks per week.
It is good to restrict the consumption of seafood and fish, which are foods rich in purines, especially if one has noticed that one or the other of these foods has triggered the crisis.
Do not consume foods high in fat.
Drink 2 to 3 liters of liquid per day, at least half of which must be water.
Other changes in diet, varying from one person to another depending on the state of health, can be beneficial. It is better to consult a nutritionist for personal advice.
Thursday, November 24,2016-13:19:38[London]
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