Gout is a kind of arthritis that mostly occurs in the small and distal joints of, mainly, the   feet. It occurs because of high uric acid levels in the blood.

Primary gout occurs because of no apparent   underlying cause for raised uric acid levels and is exclusively a disease of men. Men aged 40 or more are commonly affected. Secondary gout, one in which uric acid levels are raised in the blood due to some disease like kidney problems, can occur in both men and women and at any age.

Production of excess uric acid in the body, exceeding the body’s capacity to dispose it, is the main reason for precipitation of gout. Primary gout is mostly hereditary but the attacks are influenced by environmental factors. 

A typical attack starts in great toe. Other sites that can be affected are foot, ankle, knee, small joints of hands and elbow. There is sudden onset of pain in the affected part, which is severe and excruciating.  

Symptoms

The sufferer is unable to sleep because of the pain. The affected part becomes sensitive to the extent that even the bed clothes hurt. There is localised swelling.  

The symptoms subside completely within five to 14 days. Second attack may occur within six to 12 months. With each subsequent attack, more joints may be involved and the attack may become more severe. In some people, especially in the elderly, the episodes of gout become chronic and deposits of crystals of derivative of uric acid metabolism are formed over affected joint. These form swellings known as tophi.  Chronic gout can lead to deformities of the joints over the years, disabling a person.

The main precipitating factor for acute attacks of gout is alcohol, especially beer. A man may take beer in the evening and spend the night suffering from gout. Red meat and offal, tomatoes and spinach have also been implicated. 

Gout is more commonly seen in obese men, thus creating a vicious cycle. An obese man may develop gout and then find it difficult to do any exercise because of pain, further aggravating the obesity.    

Secondary gout occurs commonly because of drugs that increase uric acid levels in the blood. These are diuretics like frusemide, anticancer drugs like methotrexate. 

Renal failure tends to cause gout because of defective excretion of uric acid from the body.   High uric acid levels can lead to formation of stones in the kidney, thus contributing to or aggravating renal failure, which may further augment the gout.

Diagnosis and treatment

Diagnosis of gout is made by high uric acid levels in the blood or finding the metabolite  crystals in the fluid exuded from the tophi of affected joints.

There is no total amelioration for gout. During the acute attack of pain, any pain relieving medication can provide some relief. But colchicine and allopurinol provide greater relief in episodes of agony. Colchicine often causes diarrhea in the dose used for gout. Allopurinol also causes digestive disturbances. 

Considering the troublesome and recurrent nature of the disease it is better  to take  precautions  to avoid an attack. Beers are best avoided.   Red meat, offal, peas, etc should be eaten sparingly. Drinking plenty of water ensures good functioning of the kidney and helps excrete excess of uric acid from the body.

 Regular exercises of joints certainly helps those suffering from recurrent acute or chronic gout. Exercise makes the joints more flexible and reduces intensity of suffering.

Dr Rachna Pande is a specialist in internal medicine at Ruhengeri Hospital