Gout is a form of arthritis. Arthritis literally means inflammation of one or more joints and is usually accompanied by pain and swelling in the affected joints. At first, gout arthritis tends to affect only one joint — most frequently in the big toe. Gout arthritis happens in people who have too much uric acid in the blood. Uric acid is a chemical that is produced when the body breaks down certain foods. Uric acid can form sharp needle-like crystals that build up in the joints and cause pain. Uric acid crystals can also form inside the tubes that carry urine from the kidneys to the bladder. These crystals can turn into "kidney stones” that can cause pain and problems with the flow of urine. Kidney stones caused by uric acid crystals occur in approximately 15 percent of people with gout

Not everyone with high blood uric acid levels develops gout; up to two-thirds of individuals with this elevated blood uric levels never develop symptoms of gout.

Symptoms

Gout attacks cause sudden severe joint pain, often with redness, swelling, and tenderness of the joint. Although an attack typically affects a single joint, some people develop a few inflamed joints at the same time. The pain and inflammation are worst within several hours and generally improve completely over a few days to several weeks, even if untreated.

Gout arthritis disease usually comes in three classic phases; Attacks of gout usually involve a single joint, most often the big toe or knee and this is called acute gout arthritis followed by a phase of a second attack typically occurring within two years and additional attacks may occur thereafter. If gout is untreated over a period of several years, the time between attacks may shorten, and attacks may become increasingly severe and prolonged. Over time, the attacks can begin to involve multiple joints at once and may be accompanied by fever. The third phase occurs due to accumulation of large numbers of the uric acid crystals in masses called ‘tophi’ that appear over time in joints, bones, and cartilage or under the skin. Tophi may cause erosion of the bone and eventually joint damage and deformity.

The presence of tophi near the knuckles or small joints of the fingers can be a distressing cosmetic problem. Tophi are usually not painful or tender. However, they can become inflamed and can cause symptoms like those of an acute gouty attack.

What increases risk for gout arthritis

Everyone can suffer from gout arthritis and most commonly first develops in men between ages of 30 and 45 and in women between 55 and 70. In both men and women, gout is particularly common in individuals over 65 years of age.

There are known factors that increase the risk for suffering from gout arthritis such as; Obesity, poorly controlled high blood pressure, injury or recent surgery, fasting, consuming excessive amounts of alcohol (particularly beer, whiskey, gin, vodka, and rum) on a regular basis, overeating, regular diets containing large amounts of meat, seafood, and high fructose corn syrup-containing beverages, such as non-diet sodas and some taking some medications that affect blood levels of uric acid.

Diagnosis

The diagnosis of gout arthritis is made by taking proper history of the patient’s symptoms, physical examinations and some investigations to confirm the diagnosis. The best way to diagnose gout is to examine synovial fluid from an affected joint to look for uric acid crystals in the sample. To obtain the fluid, the provider uses a needle and syringe to withdraw a small amount of fluid from inside the joint.

There are many illnesses that can cause joint pain and inflammation. Gout is strongly suspected if a person has an acute attack of joint pain, followed by a period in which there are no symptoms. It is important to confirm the diagnosis of gout to ensure that potentially harmful medications are not taken unnecessarily over a prolonged period of time.

Management

The goal of treatment of flares of gouty arthritis is to reduce pain and inflammation quickly and safely. It may be necessary to use more than one drug to achieve this goal. Deciding which medication to use, the doctor bases on several factors, including a person’s risk of bleeding, his kidney health, and whether there is a past history of an ulcer in the stomach or small intestine. Anti-inflammatory medications are the best treatment for acute gout attacks and are best started early in the course of an attack.

People with a history of gout should keep medication on hand to treat an attack because early treatment is an important factor in determining how long it takes to decrease the pain and severity of an attack.

There are medicines that can reduce the chances of having future gout attacks. Most people who have repeated or severe attacks of gout need to take these medicines. In general, they all work by reducing the amount of uric acid in the blood

In addition to medical treatment, life style modification can help in prevention of future gout attacks and overall risk of suffering from gout arthritis for people with no gout arthritis. Cutting down on red meat and seafood, beer and hard alcohol(such as gin or vodka), foods and drinks that have high-fructose corn syrup (that includes most sodas, and store-bought cakes and cookies), and instead feeding on diets with Low-fat dairy products such as low-fat milk, cheese, and yogurt and whole grains and vegetables.

Dr. Ian Shyaka is a General Practitioner at Rwanda Military Hospitaliangashugi@gmail.com