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What is Gout?
Gout is a metabolic inflammatory disease; it has been around as long as civilization. Medical reports from the 1600's describe Gout attacks and various explanation of causes. Gout is usually hereditary, Primary Gout and is caused by an increase in the formation of uric acid in the blood stream. Secondary Gout can occur due to other metabolic causes of increased uric acid in the blood stream.
Everybody forms uric acid as a breakdown of amino acids, it is usually excreted in the urine. The problem starts when there is an increase in the production of uric acid or a decrease in excretion of uric acid. This causes Hyperuricemia in the blood and then these crystals cause inflammation in the joints or bursa.
Benjamin Franklin, a suffer of gout is thought, to have brought colchicine from France to the US for treatment of his gout.
Gout Symptoms and Anatomy
Sudden onset of acute pain in a joint without a history of trauma should be a concern for gout. Local swelling with redness and extreme tenderness, frequently coming in the middle of the night. Patients may feel feverish, and achy. Gout occurs more frequently in men than in women and usually first occurs after the age of 35. When it occurs in the foot it has a tendency to affect the big toe and is called podagral. Serum Uric acid is commonly but not always elevated, uric acid crystals in the joint or soft tissue is diagnostic for gout.
Chronic gout can cause nodules of uric acid deposits called tophi, they occasionally will leak a substance that is chalky and white. Arthritis does form in chronic case and deformity of the joints can occur.
Prognosis is good despite the severe pain most people can control their gout attacks with medications and diet.
Gout Treatment Options
Initial treatment of an acute gout attack is usually treated with oral medications of colchicine, along with an anti-inflammatory (NSAID or Steroid). Limiting the movement of the painful joint is helpful and most attacks will last 3-5 days.
Controlling the recurrence of the attacks is done by reducing the uric acid levels in the blood stream. Medications such as allopurinol, colcrys, and colchicine can manage the levels of uric acid in the blood. Diets low in Purine (an amino acid) can reduce the production of uric acid.
Surgery is only needed if chronic gout has caused the destruction of the joint as to cause ongoing pain even when a gout attack is not present. Debridement of tophi (Nodules) are done when they are too large to accommodate shoe wear or interfere with mobility. If the joint is damaged, then fusion or replacement may be necessary.