What is Gout?

  • Gout is a form of inflammatory arthritis which develops when there is high levels of uric acid in the blood.
  • Accumulation of acid leads to the formation of needle-like crystals in a joint, resulting in sudden, severe episodes of pain, tenderness, redness, warmth and swelling.
  • Gout usually affects men aged over 40 with a family history of gout.

What are the signs and symptoms?

The signs and symptoms of gout include:

  1. Intense joint pain. This occurs usually at the base of the big toe but can affect other joins as well, including the feet, fingers, wrists, elbows, knees and ankles.
  2. Inflammation and redness. The affected joint becomes swollen, hot, shiny red and stiff.
  3. Fever as high as 39°C, with or without chills.
  4. Limited range of motion. Pain affects the patient movement and quality of life.

Who are at risk?

  • Family history of gout.
  • Food intake rich in purines, such as meat, shellfish, anchovies, dried peas, beans and sweetbreads.
  • Large intake of alcohol.
  • High levels of triglycerides.
  • Obesity increases risk for gout.
  • Those who have undergone gastric bypass surgery have an increased risk.

What causes it?

  • Gout is caused by excess uric acid in the blood (hyperuricemia).
  • Uric acid is produced during the breakdown of purines – chemical compounds that are found in certain foods such as meat, poultry, liver, wine, beer, seafood, dried peas and beans.
  • Excess uric acid tends to accumulate in tissues in the form of needle-like crystals that cause pain.

Stages of Gout

1. Asymptomatic hyperuricemia

  • Period prior to the 1st gout attack.
  • No signs and symptoms.
  • Blood uric acid levels are high and crystals are forming in the joint.

2. AcuteGout

  • Happens when something (e.g. alcohol) causes uric acid levels to spike.
  • The resulting inflammation and pain usually strike at night and intensify over the next 8 to 12 hours.
  • The symptoms ease after a few days and likely go away in a week.

Acute gout attack with classic podagra and synovitis in the second metacarpophalang eal joint.

3. IntervalGout

  • Period in between attacks of acute gout.
  • This is the time to begin managing gout via lifestyle changes and medications to prevent chronic gout.

4. Chronic Gout

  • Develops when uric acid levels remain high over a number of years.
  • Permanent damage may have occurred in the joints and the kidneys.

What To Do During Acute Gout Attack?

  • Take an anti- inflammatory medication as soon as possible
  • Drink plenty of fluids (no alcohol or sweet sodas)
  • Ice and elevate the joint
  • Relax; stress can aggravate gout.

Dietary Modifications

  • Limit meat and seafood intake (e.g. sardines, mussels, mutton) as they are purine-rich.
  • Weight loss in obese patients can reduce risk of gout attacks.
  • Avoid excessive drinking of alcohol because it elevates serum uric acid, precipitating gout attacks.
  • Restrict sodas or foods sweetened with high-fructose corn syrup as it was found to increase the risk of hyperuricemia by 1.8 fold.

What supplements can help?

Cherries

High level of anthocyanins in cherry lowers uric acid level and reduces inflammation.
Cherries exert their urate-lowering effect by helping the body to eliminate uric acid via the urine.

Consuming 225g of cherries or drinking the juice may reduce the incidence of gout attacks.

Celery

Celery was shown to have protective effects against gout by having considerable xanthine oxidase inhibitory activity.

Not only does it decrease uric acid levels, but it also relieves symptoms of immobility and joint pain

Vitamin C

It is a water-soluble antioxidant that potentially reduces serum uric levels by increasing urinary excretion.

Intake of 500mg/daily or higher was shown to reduce serum uric acid.

Reference:

  1. What is Gout? [Internet]. Arthritis.org. 2018 [cited 11 February 2018]. Available from: https://www.arthritis.org/about- arthritis/types/gout/what-is-gout.php
  2. Gout [Internet]. University of Maryland Medical Center. 2018 [cited 11 February 2018]. Available from: https://www.umm.edu/health/medical/altmed/condition/gout
  3. Gout | Gouty Arthritis | MedlinePlus [Internet]. Medlineplus.gov. 2018 [cited 19 February 2018]. Available from: https://medlineplus.gov/gout.html
  4. Detecting and Treating Gout | NIH MedlinePlus the Magazine [Internet]. Medlineplus.gov. 2018 [cited 19 February 2018]. Available from: https://medlineplus.gov/magazine/issues/winter12/articles/wint er12pg16-17.html
  5. McIntosh J, University of Illinois-Chicago S. Gout: Symptoms, causes, and treatment [Internet]. Medical News Today. 2018 [cited 19 February 2018]. Available from: https://www.medicalnewstoday.com/articles/144827.php
  6. Tausche A-K, Jansen TLm Schroder H-E, Bornstein SR, Aringer M, Muller-Ladner U. Gout- Current Diagnosis and Treatment. Deutsches Arzteblatt international. 2009; 106(34-35):549-555.
  7. Gout Treatment [Internet]. Arthritis.org. 2018 [cited 19 February 2018]. Available from: https://www.arthritis.org/about- arthritis/types/gout/treatments/types.php
  8. Falasca G, Natalie Dubchak. New and improved strategies for the treatment of gout. International Journal of Nephrology and Renovascular Disease. 2010;:145.
  9. Hainer B, Matheson E, Wilkes RT. Treatment, and Prevention of Gout. American Family Physician. 2014 Dec 15;90(12):831-836.
  10. Ragab G, Elshahaly M, Bardin T. Gout: An old disease in new perspective A review. Journal of Advanced Research. 2017;8(5):495-511.
  11. Bernal J, Quilis N, Andrés M, Sivera F, Pascual E. Gout: optimizing treatment to achieve a disease cure. Therapeutic Advances in Chronic Disease. 2016;7(2):135-144.
  12. Zhang Y, Neogi T, Chen C, Chaisson C, Hunter D, Choi H. Cherry consumption and decreased risk of recurrent gout attacks. Arthritis & Rheumatism. 2012;64(12):4004-4011.
  13. S. M. Abd El-Rahman H. Xanthine Oxidase Inhibitory Activity and Antigout of Celery Leek Parsley and Molokhia. Advances in Biochemistry. 2015;3(4):40
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