Orthopedic Diseases
Gout
 

​​Overview:

  • Gout is a form of arthritis, causing sudden onset of severe pain, swelling, and redness of a joint.
  • Urate can form crystals that build up in different parts of the body, causing symptoms, such as kidney stones and associated problems. 
  • Gout is a complex disease and many factors play a role in its occurrence. 
  • The goal of treating gout attacks is to reduce pain, inflammation and complications. 
Definition:
Gout is a form of arthritis, with an increase in the uric acid level in the bloodstream, causing severe pain in the joints and may be accompanied by swelling, redness and heat. It commonly develops in adult men (often between the ages of 30 and 45) than in women (usually after age 55); it is particularly common in people older than 65 regardless of gender. Gout is rare in children. 

Stages of Gout:
  • First stage, the level of uric acid starts to rise without side effects.
  • Second stage, acute gout attacks that may last for days.
  • Third stage, severe symptoms between attacks, usually last for months or years.
  • In the last stage, the condition develops into chronic gout in the event that the appropriate treatment is not received.
Other names:
Gout, disease of kings.

Cause:
It is caused by accumulation of the uric acid in the bloodstream, it is a condition called hyperuricemia, and accumulation of small crystals in the joints causing inflammation.
 
Risk Factors:
Gout is a complex disease and many factors play a role in its occurrence, such as:
  • Obesity.
  • Genetic factors.
  • Some medical conditions where uric acid is high (such as: high cholesterol, high blood pressure, diabetes and heart disease).
  • Certain medications may increase uric acid levels such as diuretics.
  • Age and gender, it is more common in men than in women under 60 years of age.
  • Red meat, shellfish and some protein-rich foods increase uric acid levels.
  • Soft drinks.
  • Joint injuries.
  • Recent surgery or trauma.
  • Chemotherapy. 
  • Chronic kidney disease.
  • Overeating or fasting for a long time.
The risk factors for recurrence of gout: 
  • Injury or recent surgery.
  • Drinking alcohol.
  • Overeating.
  • Dehydration.
  • Taking medications that induce sudden changes in blood urate levels. 

Symptoms:
- Gout flares (also called gout attacks) are sudden episodes of severe joint pain, usually involving redness, swelling, and tenderness of the joint. Although a gout flare typically affects a single joint, some people develop several inflamed joints at the same time. Gout flares start more often during the night and in the early morning hours than during the day, but they can occur at any time. The pain and inflammation usually reach peak intensity within 12 to 24 hours and generally improve completely within a few days to several weeks, even if untreated.
 
Phases of Gout:
  • Gout flare: Initial gout flares usually involve a single joint, most often the big toe or knee. Over time, flares can begin to involve multiple joints at once and may be accompanied by fever.
  • Intercritical gout: The time between gout flares is known as an "intercritical" period. A second gout flare typically occurs within two years, but if not treated properly, it may happen before that.
  • Tophaceous gout: People who have repeated gout flares or persistent hyperuricemia for many years can develop tophaceous gout. This term describes the accumulation of large numbers of urate crystals in masses called "tophi." Tophi may cause erosion of the bone and eventually joint damage and deformity (called gouty arthropathy).
Complications:
  • Accumulation of crystals in the joints may not be accompanied by pain, but can cause damage to the joints, bones, and cartilage.
  • Joint damage and deformity.
  • Kidney stones.
  • Kidney diseases or kidney failure. 
Diagnosis:
There are many illnesses that can cause joint pain and inflammation. Gout is diagnosed if a person has one or more acute attacks of joint pain, followed by a period in which there are no symptoms but there is persistent hyperuricemia. Tests to help diagnose gout may include:
Medical history.
Blood tests.
Physical examination.
X-ray imaging, ultrasound, CT scan.
The best way to diagnose gout is for a doctor to examine the fluid lining of the affected joint (synovial fluid) under a microscope to look for urate crystals. Also, the doctor focuses on the intensity of pain, the attack length and the affected joints. 

Treatment: 
The goal of treatment of gout flares is to reduce pain, inflammation, and complications quickly and safely. This treatment is usually short-term and limited to the duration of the flare. Deciding which medication to use is based upon several factors, including the risk of bleeding, kidney health, and whether you have a past history of an ulcer in the stomach or small intestine.

  • Anti-inflammatory medications are the best treatment for gout flares. They are most effective when started early in the course of a flare and they work to reduce swelling in the joint (such as: ibuprofen and indomethacin). If you have a history of gout, your doctor can give you medication to keep on hand in the event of a flare. This is important because early treatment is key in minimizing the amount of time it takes to decrease the pain, severity, and duration of a flare.
  • Preventive Treatment: It aims to prevent or reduce the occurrence of gout flares. It usually recommended by the doctor and is taken daily at low doses to avoid gastrointestinal side effects. ​
Prevention:
Adopting healthy lifestyle habits is a key part of an effective gout treatment and prevention plan, including: 
  • Healthy food: Eating healthy foods help reduce the level of uric acid in the blood:
    • All types of vegetables.
    • Low-fat dairy products.
    • Whole grain.
    • Vegetable oils.
    • Certain types of fruits.
    • Vitamin C.
    • Drink plenty of fluids particularly water. 
Physical activity: Exercising and starting to lose extra pounds, helps reduce uric acid, and protects against injury.









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