Parish Nurse

From the Parish Nurse – November 2017 ….




Signs and Symptoms – Severe pain that strikes suddenly in a single joint, often at the base of your big toe, accompanied by swelling and redness.

Also called crystal-induced arthritis, gout occurs when uric acid crystals accumulate in the affected joint.  Some uric acid is derived from a food substance in the diet known as purines, but the greater part is produced by our bodies daily.  If you have gout, you lose the normal balance:  your body produces too much uric acid or too little is excreted.  When the amount of uric acid in your blood and body fluids increases, uric acid in the fluid around the joints (synovial fluid) forms crystals and gout results, typically in the joint at the base of your big toe.

Ninety percent of persons with gout are men older than 40; 1 in 4 has a family history of the ailment.  Gout has long had a reputation as an illness that results from the excessive consumption of food and drink, which may be true, but gout also can strike at any time and for no apparent reason.  People who are obese or who suffer from hypertension may be at greater risk for crystal-induced arthritis.  The stress of an injury such as a fracture or a surgical procedure may provoke an attack.  Thiazide diuretics, a common treatment for high blood pressure that reduces the water content of the body, may raise uric acid levels in the blood and provoke gout in the susceptible person.

Diagnosis – An episode of gout begins within a matter of hours.  A joint that seemed entirely normal will become intensely painful, red and swollen.  The joint will remain very painful for several days.  The discomfort will subside gradually over the next 1 to 2 weeks, leaving the joint apparently normal and pain-free.  Even though the joint at the base of the great toe is involved most frequently, gout can affect other joints in the feet, ankles, knees, hands and wrists.

To confirm the diagnosis, your physician may withdraw some fluid from the affected joint to look for crystals of uric acid within the white blood cells.  Your physician also may do blood tests for levels of uric acid; but the tests can be misleading, because the levels may be nearly normal during an acute attack of gout.  In addition, many people with high levels of uric acid never experience an attack of crystal-induced arthritis.

Sometimes, a long-term accumulation of uric acid may produce lumps, called tophi, just beneath the skin.  The most common site is the cartilage of the ear.  Infrequently, kidney stones may result from the build-up of uric acid.

What is Pseudogout?  Pseudogout is a related ailment that involves the deposit of crystals of a calcium salt rather than uric acid in the joints.  The affected joints are more likely to be knees, wrists and ankles than those of the foot.  Pseudogout strikes women and men with roughly equal frequency, but the age at onset is late, typically 70 years.  The ailment is also known as calcium pyrophosphate dihydrate crystal deposition disease.

How serious is Gout?  Your physician can treat an acute attack effectively and prevent future attacks by giving you maintenance medication.  After an attack has run its course (generally a matter of days and no more than a few weeks), the affected joint usually returns to normal.  If you do not receive proper treatment, however, joint damage can be permanent and uric acid deposits may cause kidney problems or even stones.

Treatment – Colchicine, in use for centuries, is still valuable for acute attacks of gout.  Indomethacin is also used for acute attacks.  Between attacks your physician may use other drugs, including probenecid and allopurinol, to control the levels of uric acid in your body.

Physicians usually treat pseudogout with anti-inflammatory drugs, although colchicine is effective in some cases.

Although physicians no longer consider food and drink the main cause of gout, avoid excessive consumption of alcohol, maintain your weight within reasonable limits, and avoid foods that contain purines if you have gout.  Purine-rich foods include sardines, anchovies, sweetbreads, liver and kidney.  Remember attempts at rapid weight reduction may provoke an acute attack.

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