Gout-a painful experience

Gout is a kind of arthritis or inflammation of joints, which mostly occurs in the small and distal joints of the body, mainly of the feet. This condition occurs because of high uric acid levels in the blood. Primary gout i.e. the one which occurs because of no apparent underlying cause, for raised uric acid levels is exclusively a disease of men. Men around 40 years or more of age are commonly affected. Secondary gout, i.e. the 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 off, is the main reason for precipitation of gout, whether primary or secondary. The primary variety of gout is mostly hereditary, i.e. it runs in families but the attacks are influenced by environmental factors. A typical attack starts in the big toe in majority of cases. Other sites which may 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. The sufferer has to get up in bed and is unable to sleep because of the pain. Along with pain, the affected part is extremely tender, to the extent that even the bed clothes hurt. There is localized swelling. All these symptoms subside completely within 5 to 14 days. The second attack may occur within 6 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 MSUM (monosodium urate monohydrate, derivative of uric acid metabolism) are formed over affected joints. These form swellings known as tophi. Chronic gout can also lead to deformities of the joints over the years, disabling the person. The main precipitating factor for acute attacks of gout is alcohol, especially beer. A man may take a binge in the evening and spend the night suffering from gout. Red meat, offal, tomatoes and spinach have also been implicated. It 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 which increase uric acid levels in the blood. These are diuretics like frusemide which are used to increase the disposal of excess fluid from the body, anti cancer drugs like methotrexate. Renal failure tends to cause gout because of defective excretion of uric acid from the body. Gout not only affects the joints but, high uric acid levels can lead to formation of stones in the kidney, thus contributing to renal failure, which may further augment the 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 or total amelioration for gout. During the acute attack of pain, any pain relieving medication can provide some relief. But colchicines and allopurinol provide greater relief in episodes of agony. They are not free from side effects. Colchicine often causes diarrhea in the dose used for gout. 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 to take precautions to avoid an attack. Beers are best avoided. Red meat, offal, peas, e.t.c should be used sparingly. Drinking plenty of water ensures good functioning of the kidney and helps excrete excess of uric acid from the body. Doing regular exercises of joints would certainly help those suffering from recurrent acute or chronic gout. Exercise makes the joints more flexible and reduces intensity of suffering. With certain precautions a person suffering from gout can lead a normal and comfortable life. rachna212002@yahoo.co.uk