GOUTY ARTHRITIS (GOUT), HOW TO TREAT GOUT, GOUT WHAT FOODS TO AVOID.
This is a disorder of uric acid metabolism whereby urate crystal deposit in the joints and other body tissues. It's usually caused by excessive concentration of uric acid in the blood (hyperuricermia) the disease affect, toe, foot, ankle, knee, hand and elbow joints. Its common in males than females. Gout is a kind of arthritis that is caused by accumulations of uric acid crystals in the joints. Uric acid is a product from the breakdown of purines which is part of the many foods we eat. An abnormality resulting from deposits of uric acid and crystallization of purine compounds in the joints can cause attacks of painful arthritis, kidney stones and blockage of the kidney filtering tubules with uric acid crystals, leading to kidney failure. Gout arthritis is recorded as the most frequent medical illness of all times(historically), thus in considering Gouty arthritis, how to treat gout, it is important to also consider gout what foods to avoid.
PEOPLE AFFECTED BY GOUTY ARTHRITIS
In the United States the prevalence of gout has increase in the last twenty years and now affects about 8.3million people(4%) of the American populace. It is more common in African-American men than white men. The prevalence of Gout Arthritis increase with age and with a peak age of 75. Gout case occurs in women after menopause. People with Hyperuricemia (elevated blood uric acid level) are likely to develop gout.
RISK/PREDISPOSING FACTORS OF GOUTY ARTHRITIS
- People with excessive weight gain and obesity especially in youth,
- Moderate to heavy alcohol intake
- High blood pressure and abnormal kidney function are risk factors for developing gout arthritis
Some drugs and diseases also increases the levels of uric acid, more so, in patients with gout there is prevalence of abnormally low thyroid hormone levels (Hypothroidism)
other factors includes
- High Alcohol intake
- Genetic predisposition
- High intake of foods rich in purines e.g sea foods (gout what foods to avoid)
- Drugs e.g Diuretic (fluid drugs)
- injury to joints
- Long standing kidney disease
Excessive concentration of uric acid in the blood either due to over production or faulty disposal or elimination to the kidney leads to accumulation and deposition of urate crystals within the joint tissues, thereby setting up irritation and local inflammatory response causing tenderness and swelling of the affected joints. Small masses of the urate crystals, called tophi are also formed in the cartilage, kidneys and soft tissues of other parts of the body resulting in systemic symptoms like anorexia nausea and fever.
Acute cases of gout arthritis is marked from the onset with intense pain from the joint affected accompanied with increase temperature (warmth), swelling, tenderness, reddish coloration. The most common site for the attack above is the joint at the base of the big toe. Other joints can be affected too they include joints of the ankles, knees, wrists, fingers and elbows. In some patients, cases of acute pain can be so intense that the patient will feel severe pain even if a bed sheet touches the toe. These severe pains usually subside in hours or days if or if no medication is applied. In rare cases. an attack can last for weeks. Patients with gout arthritis will experience repeated bouts over the years.
Some Parts of The Body Affected By Gouty Arthritis
The Big toe: The most common site for acute gout attack is the joint at the base of the big toe. The attack can recur if gout is not treated. Gout patients should see a doctor for treatment even if the pain from gout is gone because it can harm the joints, tendons and other tissues
Gout patients may experience deposits of uric acid crystals in their finger joints, during a gout attack, to ease the pain, the person should rest the joint that hurts.
The elbow and the knee joints are attacked by Gout. There is protrusion on the elbow
other gout symptoms includes:
- Severe pain
- Tenderness in the affected joint
- swelling of the affected joint
- Warm, tight, shiny and red skin of the affected joint
DIAGNOSTIC EVALUATION (How to treat gout)
- Examination of the joint and full medical history of severe pain, tenderness and swelling
- Blood analysis will reveal elevated uric acid level (normal levels 0.18 0.42mmol/L). Results may be normal in gout when crystals are settled in the joints
- Aspiration of joint fluid to confirm the presence of uric acids crystals
- X-ray of affected areas may reveal joint damage
DIAGNOSING GOUTY ARTHRITIS: Joint Fluid Analysis
When a patient begins to complain of repeated cases of painful arthritis then Gout is considered, especially when it occurs at the toes or in the ankles and knees. The most efficient and reliable test for gouty arthritis is detecting uric acid crystals in the joint fluid which is obtained by joint aspiration. The common office method that is employed is performed with tropical anesthesia, Using sterile technique, fluid is aspirated (i.e withdrawn) from the inflamed joint with a syringe and needle. Once the joint fluid is obtained, it is then analyzed for the presence of uric acid crystals and infection. A medical personnel (doctor) may also do a blood test to measure the amount of uric acid present in the patient's blood.
HOW TO PREVENT GOUT ATTACKS
Maintaining an adequate fluid intake/level is one of the best measure which helps to prevent acute gout attacks and it decreases the risk of kidney stone formation in gout patients. On the other hand alcohol is known to have diuretic effects such that it can contribute to dehydration and precipitate acute gout attacks. Alcohol can also have an effect in uric acid metabolism and can also cause hyperuricemia as earlier stated. Alcohol causes gout through slowing down the excretion of uric acid coming from the kidneys as well as by causing dehydration, which precipitates the uric acid crystals in the joints.
Other prevention techniques includes dietary changes ( gout what foods to avoid), it helps to reduce uric acid levels in the blood. Purine -rich food are contributive to gout attacks , thus they should be avoided since purine chemicals are converted by the body into uric acid. As stated earlier purine-rich foods includes shellfish and organ meats, such as liver, brains and kidneys. So many researchers have reported that meat or consumption of sea food increases the chances/risk of gout attacks, while diary consumption seemed to reduce such risk/chances. Weight reduction can also be helpful in reducing the chances/risk of reoccurring attacks of gout.
MANAGEMENT (How to treat Gout)
Management is aimed at relieving pain and inflammation of acute attacks and preventing the occurrence of future attacks
- Pharmacology: non-steroidal anti-inflammatory drugs (NSAIDs) such as indomethacis, naprosyn or diclofenac are taken to reduce duration and severity of attack. Paracetamol is taken in conjunction with other medications.
Aspirin should be avoided as it can reduce the amount of uric acid excreted by the body. Colchicines can be taken to block the production of uric acid.
- Steroids e.g. prednisone may be given in tablet form to reduce pain and inflammation (Allopurinol uricosuric, drugs and probenecid) are used to either reduce uric acid by the kidneys
MORE INFO IN TREATING GOUT WITH THE USE OF MEDICATIONS
There are certain medications that can reduce the pain and inflammation that results from gout attacks, they include:
- anti-inflammatory drugs such as Ibuprofen and naproxen , colchicine and coorticosteroids.
- Other effective medications decreases the level of uric acid that is present in the blood and also prevent the deposition of uric acid crystals in joints gouty arthritis), the kidney (stones) and in tissue (tophi), it helps to prevent further attacks and complications. Drugs like that includes the following: allopurinol, febuxostat, lesinurad and probenicid.
NURISNG MANAGEMENT (How to treat Gout)
- On admission, patient is placed on bed rest and the affected part immobilized
- Hot or cold applications to the affected joints will provide some relief
- Nutrition (gout what foods to avoid): Restrict food high in purines. Purine produce uric acid. Foods high in purines include shellfish, organ meats (brains, liver, kidney, yeast extract as milk, alkaline foods such as potatoes and citrus fruits. Reduce alcohol intake which can cause diuresis and increase the concentration of the internal environment which encourages accumulation of uric acid,
- Drinking plenty of fluid (2500-3000ml per day) will help flush uric acid crystals out of the body
- Maintain body weight to reduce stress on the affected joints.
- On discharge, the patient's family should be advised on intake of copius fluid, dietary regimen, application of warm/cold compresses and side effects of drugs
- Chronic pain related to inflammatory response and irritation of the joints by uric acid evidence by patient's complain
- Hyperthemia related to inflammatory process evidence by temperature of 38oC
- Knowledge deficit as regard management of the condition evidence by frequently questioning and non compliance to treatment plan
- Permanent damage to the joints
- Kidney stones
- Loss of function
- Cerebrovascular accident
SCIENTIFIC FATE OF GOUTY ARTHRITIS
There is active research current going on in various fields related to gout and hyperuricemia. Scientists have discovered that animal protein slight increases the risk/chance for gout attacks. and there are new drugs that are currently being developed that may have increased versatility and also safe in treating the increased rate of uric acid levels in patients with chronic gout