Gout

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Gout is a type of inflammatory arthritis caused by the accumulation of uric acid crystals in the joints, leading to sudden and severe episodes of pain, swelling, redness, and tenderness. It most commonly affects the joint at the base of the big toe but can also occur in other joints.

Signs & Symptoms

  1. Acute gout attacks:

    • Intense joint pain, often starting at night.
    • Redness and warmth around the affected joint.
    • Swelling and tenderness, making movement difficult.

  2. Chronic gout:

    • Recurrent flare-ups over time.
    • Formation of tophi (hard uric acid deposits) under the skin.
    • Joint damage and deformities in advanced cases.

  3. Systemic symptoms:

    • Fever during severe attacks.
    • Malaise and fatigue.

Anatomy Affected

  1. Joints:

    • Primarily affects the metatarsophalangeal (MTP) joint of the big toe.
    • Other affected joints include ankles, knees, elbows, wrists, and fingers.

  2. Kidneys:

    • Chronic hyperuricemia can lead to kidney stones or damage.

Cause/Transmission

  • Hyperuricemia:
    • Elevated levels of uric acid in the blood, leading to the formation of urate crystals in the joints.
  • Risk factors:
    • Dietary: High intake of purine-rich foods (e.g., red meat, seafood) and alcohol.
    • Medical conditions: Obesity, hypertension, diabetes, and kidney disease.
    • Medications: Diuretics, aspirin, and certain immunosuppressants.
    • Genetics: Family history of gout increases susceptibility.

Treatments

  1. Medications:

    • Acute attack relief:
      • Nonsteroidal anti-inflammatory drugs (NSAIDs): E.g., ibuprofen, naproxen.
      • Colchicine: Reduces inflammation specifically related to gout.
      • Corticosteroids: For severe cases or patients unable to take NSAIDs.
    • Long-term management:
      • Xanthine oxidase inhibitors: E.g., allopurinol, febuxostat, to reduce uric acid production.
      • Uricosurics: E.g., probenecid, to enhance uric acid excretion.

  2. Lifestyle modifications:

    • Maintain a healthy weight.
    • Stay hydrated to reduce uric acid concentration.
    • Limit purine-rich foods and alcohol consumption.

Prevention

  1. Dietary changes:
    • Reduce intake of red meat, shellfish, and sugary beverages.
    • Increase consumption of low-fat dairy, fruits, and vegetables.
  2. Regular exercise:
    • Helps maintain a healthy weight and reduce uric acid levels.
  3. Monitor uric acid levels:
    • Regular check-ups to detect and manage hyperuricemia.
  4. Avoid triggers:
    • Identify and avoid personal dietary or lifestyle triggers.

Prognosis/Outlook

  • Acute attacks:
    • Pain resolves within a week with treatment, but recurrence is common without lifestyle changes or medications.
  • Chronic gout:
    • Can lead to joint damage and tophi formation if untreated.
  • Prognosis with treatment:
    • Excellent when managed appropriately. Medications and lifestyle changes significantly reduce flare-ups and complications.
  • Mortality rate:
    • Gout is not directly life-threatening, but associated conditions like cardiovascular disease and kidney issues may increase mortality risk.

Gout is a manageable condition with early intervention, proper medication, and lifestyle adjustments. Patients can maintain a high quality of life by adhering to treatment plans and preventive measures.

Comments

Anonymous said…
Most hyperuricemia, and gout in those genetically so predisposed, are caused by the chronic intermittent hypoxia of obstructive sleep apnea (OSA), which is grossly underdiagnosed and is the reason that most gout flares originate during sleep. OSA's episodes of reduced oxygen concurrently cause every cell in the body to abruptly produce excess uric acid, as well as reduce the solubility of uric acid in the blood by making the blood solvent itself more acidic, plus slow its removal by reducing kidney function. This physiology leads to excessive uric acid in the blood (aka hyperuricemia, possibly only during sleep, but certainly peaking at that time), and its precipitation as the urate crystals which cause a gout flare. If OSA continues for too long, it will lead to many life-threatening diseases (eg. cardiovascular diseases, stroke, hypertension, chronic kidney disease, diabetes, cancer -- all known to be comorbidities of gout as well) and premature death, which has also been found to occur in gout patients, whether or not their flares are well controlled by diet and medications like allopurinol. Resolving OSA early enough will greatly reduce the risk for developing these diseases, and will prevent further overnight, or even all, gout flares. Most gout is an early warning alarm of OSA.
February 26, 2025 at 10:48 AM
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