What is gout?
Gout is an inflammatory condition of the joints.
It affects men more often than women at a ratio of 5:1 and usually occurs after the fifth decade.
It is also referred to as “podagra” because of its frequent location in the 1st metatarsophalangeal joint (big toe). However, due to the fact that it can affect more than one joint, this term is no longer used.
What is the cause of the disease?
Gout was also called the “disease of kings” because of the excessive consumption of alcohol and meat. Gout is due to the deposition in and around the joints of monosodium urate crystals due to the large increase in uric acid levels in the blood.
Factors that trigger it
The factors that can trigger gout are:
Nutritional factors due to excessive consumption of alcohol and drinks containing fructose, as well as overconsumption of meat and seafood.
Genetic factors, where changes in the three genes (SLC2A9, SLC22A12 and ABCG2) double the risk of developing gout.
Health problems and comorbidities such as metabolic syndrome, polycythemia, lead poisoning, renal failure, hemolytic anemia, psoriasis and organ transplants.
And finally pharmaceutical preparations such as diuretics, niacin, aspirin, immunosuppressive drugs such as cyclosporine, tacrolimus, especially the combination of cyclosporine with hydrochlorothiazide.
Gout - Symptoms
The most frequent occurrence of gout crisis is usually localized at the base of the big toe (1st metatarsophalangeal joint).
In the joint, redness, tenderness, swelling and heat are observed.
Other joints may be affected less frequently such as the knee, ankle and tarsus, and even less often the wrist, elbow and hand joints.
The pain is sharp and intense. The patient characteristically reports that because of the pain he finds it difficult to walk and that he cannot even withstand the weight of bed linen. In addition to pain, other symptoms such as fatigue and fever may also coexist in rare cases.
Diagnosis of the disease
Due to the characteristic clinical picture of gout with the attack of the 1st metatarsophalangeal joint, the diagnosis is made even without taking a laboratory examination.
The laboratory test for uric acid may be elevated, but it may also be normal at 30%. If the clinical picture is not characteristic and the diagnosis is uncertain then puncture of the joint and analysis of synovial fluid are recommended. With the use of polarized light microscopy, characteristic crystals of monosodium urate are detected in the synovial fluid, thus setting the diagnosis. From the synovial fluid culture, any microbes are isolated for the differential diagnosis of septic arthritis, which may have the same clinical picture but the treatment is different. The determination of uric acid in 24-hour urine will show whether the patient's hyperuricaemia is due to increased production or decreased excretion. Finally, an impressive and within 24 hours, response to the administration of colchicine is considered by some to be a diagnostic criterion.
Gout - Treatment
The drugs used to treat acute infestation are:
· Colchicine
· Non-steroidal anti-inflammatory drugs
· Glucocorticoids
In severe resistant form of purulent gout, IL-1 inhibitors are recommended.
To treat high levels of uric acid there are drugs that reduce the production of uric acid, increase its excretion and newer ones that mimic the action of an enzyme (uricase) which is lacking in humans and for this reason the levels of uric acid in the blood increase.
Factors contributing to the prevention of gout:
· Change in the patient's eating habits. Foods containing a high percentage of purines such as: red meat (veal, pork and lamb), fatty fish and seafood (tuna, shrimp, lobster and scallops) should be reduced from his diet.
· Avoiding alcoholic beverages (mainly beer).
· Daily adequate fluid intake (8-16 glasses per day) helps to remove uric acid from the body.
· Reduction of the patient's body weight. Controlling diet and eating foods low in saturated fat increase the body's ability to eliminate uric acid.
· Avoiding repeated micro-injuries during exercises or professional activities.
· If possible, on the advice of the attending physician, discontinuation and replacement of certain drugs that increase uric acid in the blood should be carried out.
