Most people of the present society are aware of the disease ‘Gout’. Gout is also popularly called ‘rich man’s disease’ or ‘king of the diseases’. Incidence of the disease is day by day increasing due to life-style changes and dietary habits. It is known that 60% cases are genetically determined and 15% cases are related to food habits. Gout is a type of arthritis that is characterized by sudden, severe attacks of joint pain with redness, warmth, and swelling in the affected area. It usually attacks only one joint at a time. It most often strikes the joint of the great toe, where it’s also known as podagra, but other toes can also be involved.
Gout is typically a condition that occurs in middle age, is ten times more common in men than in women, is unusual in people under the age of 30, and is rarely seen in women before menopause. A first gout attack most commonly occurs around age 45. It’s most common in countries with high standards of living, mainly because diet plays a big part in this condition. It affects about 1% of the population.
When we turn the pages of medical history we know that since ancient times people were aware of this disease. In 2600 B.C. medical treatment was given for pain and swelling of great toe of foot. In 1200 A.D. Randolphus used the term ‘Gout’ for the first time. The word ‘Gout’ comes from Latin word gutta, meaning a drop of liquid.( Thinking that a drop of morbid material from the blood is deposited around the joints). Greek physician Hippocrates around 400 B.C. also did some study on such arthritis. In 1679 a Dutch scientist Antonie van Leeuwenhoek described the microscopic appearance of urate crystals. Again in 1848, English physician Alfred Baring Garrod realized that excess of uric acid in blood was the cause of gout. James Gillray, (1799) described the pain of gout as an attack by a demon or dragon. Allopurinol, the drug used to treat gout was first synthesized and reported in 1956 by Roland K. Robins .
Uric acid (C5H4N4O3 ) is a heterocyclic compound of carbon, nitrogen, oxygen, and hydrogen. It forms ions and salts known as urates. Uric acid is a product of the metabolic breakdown of purine nucleotides. High levels of uric acid are called hyperuricemia and can lead to the disease condition called gout. The chemical uric acid is associated with other medical conditions like diabetes and the kidney stones due to formation of ammonium acid urates. Normal level of Uric acid in human blood is 3 to 7 mg % in the males and 2.5 to 6.5 mg % in the females.
Causes of high level uric acid in blood: –
- Hereditary or familial.
- Diet – High intake of dietary purine like meat, seafood, fructose-sweetened drinks. Serum uric acid can be elevated due to reduced excretion by the kidneys.
- Sudden changes in diet and weight gain or loss can also lead to gout. Fasting or rapid weight loss can temporarily elevate uric acid levels.
- Certain drugs like thiazide diuretics, acetylsalicylic acid, pyrazinamide, ethambutol, nicotinic acid, cyclosporine & certain anti-cancer drugs hamper the kidneys’ ability to clear out the uric acid and thus increasing serum uric acid levels.
- Secondary causes like excessive consumption of alcohol, diseases like Hypertension.
The body normally forms uric acid when breaking down cells and proteins, releasing it into the blood stream. The uric acid usually stays dissolved in the blood and ends up being flushed out by the kidneys. When there is too much uric acid in the blood, condition is called hyperuricemia; the kidneys are unable get rid of it quickly and then it may begin to form crystals that collect in the joints, kidneys, skin, and other soft tissues. Although most people with gout have hyperuricemia, around 30% cases have normal uric acid levels during an actual attack. Meanwhile, hyperuricemia by itself doesn’t mean that a person will develop gout – generally 1 in 5 persons with high uric acid develops gout.
Signs and symptoms :
Gout can present in a number of ways, although the most usual is a recurrent attack of acute inflammatory arthritis (a red, tender, hot, swollen joint). The metatarsal-phalangeal joint at the base of the great toe is affected most often, around 50% of all cases. Other joints, such as the heels, knees, wrists, and fingers, may also be affected. Joint pain usually lasts for 2–4 hours during the night. The reason for onset at night is due to the lower body temperature at that time. Other symptoms may rarely occur along with the joint pain, including fatigue and a high fever. Long-standing hyperuricemia may result in other symptomatology, including hard, painless deposits of uric acid crystals known as ‘tophi’. Extensive tophi may lead to chronic arthritis due to bone erosion. Elevated levels of uric acid may also lead to crystals precipitating in the kidneys, resulting in stone formation and subsequent nephropathy.
Other Medical Conditions Associated with Gout
The following are some conditions that are associated with long-term gout:
- Dry eye syndrome
- Complications in the lungs (in rare cases, uric acid crystals occur in the lungs)
Treating and Preventing Gout
The first priority is to relieve pain and shorten an acute attack. Non Steroidal Anti-Inflammatory Drugs (NSAID) like Indomethacin, Naproxen,Ketoprofen and Dicloprofen are mainly used for this purpose. These medications help in reducing painful swelling. Another drug Colchicine can lessen joint pain and even end an attack in about 48 hours, but may have side effects such as diarrhea and vomiting. Some physicians use local Corticosteroid to inject directly into the joint or prescribe orally to control the disease.
For chronic gout or repeated attacks, Colchicine therapy may prevent future attacks, but it can not prevent the joint damage caused by tophi. Medications that lower the blood levels of uric acid, such as Allopurinol, Probenecid, and Sulfinpyrazone, are quite effective in preventing the attacks and joint damage. Out of these drugs, Allopurinol is most commonly used. A newer drug, Febuxostat, can be used in place of Allopurinol.
Prevention is an important part in the management gout. It is very important to control blood pressure and body weight and to drink at least 3 liters of water daily to prevent attacks. Triggering attacks also can be avoided by cutting down the following:
* Dehydrating drinks such as alcohol (wine, beer), tea, coffee, and cocoa.
* Animal proteins such as seafood, liver, kidney, heart, gizzard, prawn, meat.
* Vegetables such as peas, beans, spinach, and lentils.
Select the following healthy foods: turmeric, peppers, ginger, pineapple, cherry, lemon, watercess ((মানিমুনি). Select brown bread, cornflake, sweet potato, fruit salad. Always use sunflower or olive oil for cooking. Select a healthy life-style to avoid getting complications of gout.
(published in medical journal “AYUHOM”- September 2014, Shillong, Meghalaya)