Gout is a kind of arthritis which mostly affects the small and distal joints mainly of feet. It occurs because of high serum uric acid levels in the blood. Primary gout, that is, the one occurring because of no apparent reason for high uric acid levels. It is exclusively a disease of men, affecting them around 40 years or more of age. Secondary gout i.e. the one which develops secondary to kidney failure or some disease is seen in both elderly men and women. Production of excess uric acid is the main reason for precipitation of gout. Primary gout is mostly hereditary, but the attacks are influenced by environmental factors. Typical gout starts in great toe and the associated joint. Other sites which may be affected are, foot, ankle, knee, small joints of hands and elbow. There is swelling and sudden onset of severe and excruciating pain in the affected part. The sufferer has to get up and is unable to sleep because of the pain and sensitivity to touch. Feet hurt, even if touched by bed sores. All these symptoms subside completely within 5 to 14 days. Second attacks may occur within 6 to 12 months. With each subsequent attack more joints may be involved and the pain may become more severe. In some people, especially the elderly ones the episodes of gout become chronic and deposits of crystals of MSUM (monosodium urate monohydrate) are formed over affected joint, as swellings known as tophi. The main precipitating factor for acute attacks of gout is beer. Food items like red meat and offal have also been implicated. Among vegetarian fare, tomatoes and spinach are the ones likely to raise uric acid levels and precipitate acute gout. It is more commonly seen in obese men, thus creating a vicious cycle. Gout prevents them from exercising, thus aggravating obesity, which further can aggravate gout. There may be associated hypertension, diabetes and heart problem. Secondary gout occurs mostly due to drugs which increase uric acid levels in the blood. These are diuretics like frusemide which are used to promote urine output, hence dispose excess fluid from the body, anticancer drugs like methotrexate. Renal failure tends to cause gout because of defective uric acid excretion from the body. High uric acid levels in blood as in gout can lead to formation of stones in the kidney, thus contributing to renal failure, which in turn can aggravate gout. Diagnosis of gout is made by high uric acid levels in the blood or finding the MSUM crystals in the fluid exuded from the tophi of affected joints. There is no root cure for gout. During the acute attack of pain any pain relieving medication provides some relief. But colchicine and allopurinol provide greater relief in episodes of agony and are therefore are more useful. Colchicine often causes diarrhea. Allopurinol also causes digestive disturbances. Steroids do suppress the suffering but, have many side effects and therefore not desirable to take for long. Considering the troublesome and recurrent nature of the disease it is better for the sufferers to take more precautions and try to avoid an attack. Beers are best avoided. Red meat, offal, tomatoes and spinach are to be used sparingly. Drinking adequate water ensures good functioning of the kidney and helps excrete excess of uric acid from the body. Regular exercises certainly help those suffering from recurrent acute or chronic gout. Exercises of the joints enhances flexibility, strength and helps in reducing intensity of pain and joint deformities. With due precautions and exercises one can lead a normal and comfortable life, in spite of having gout. Dr. Rachna Pande is a specialist in internal medicine at Ruhengeri Hospital
