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Gouty Arthritis: Treatment Options By Dr. Willie T. Ong

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Gouty Arthritis: Treatment Options By Dr. Willie T. Ong

Gout or gouty arthritis is a condition that mainly affects men, but it can also develop in women after menopause.



The symptoms of gout are intense pain, redness and inflammation of the joints, usually in the feet, especially the big toe. The knees, ankles, hands, wrist and elbows can also be involved. The pain is most severe within 24 hours. After the acute attack is over, the pain may still linger for a week or so.






























Osteoarthritis versus Gout:

Many people mistake osteoarthritis with gout. Osteoarthritis is the
common type of arthritis due to ageing and the body’s wear and tear. In
contrast, people with gout often have high uric acid levels in the
blood. The affected joints and the treatment for gout are also different
from that of osteoarthritis.

What Causes Gout? In gout,
uric acid (urate) crystals form in the joint spaces (like sugar
crystals) and this brings about intense pain in the joints. Normally,
the body produces uric acid when it breaks down purines, a substance
found in certain foods such as meat, and organ meats.



If your body
produces excess uric acid or if the uric acid cannot be excreted by the
kidneys, you may develop gout. The uric acid then builds up, forming
sharp urate crystals that migrate to the joints causing irritation and
severe pain.



Ten percent of those with elevated blood uric acid
levels will eventually develop gout in the future. Those with uric acid
levels greater than 535 μmol/l (or 9 mg/dL) have a much greater risk
compared to those with slightly elevated levels only.

Risk factors for gout:
1. Genetics – Gout can be hereditary, which means you got it from your parents’ genes.



2. Men and post-menopausal women – Men usually have higher uric acid
levels as compared to women. Hence men are more prone to develop gout.
After menopause, women’s uric acid levels increase and thus, women may
later develop gout.


3. Intake of certain foods - Gout can also be aggravated by eating foods that are high in purines.



4. Excess alcohol intake – Too much alcohol can increase your risk for
gout. This is because alcohol contains purines, especially beer and hard
liquor.


5. Some medical conditions – Those with high blood
pressure, high cholesterol and diabetes may be at risk for gout. The use
of thiazides, a form of diuretics to treat high blood pressure, can
increase uric acid levels in the blood.

Dangers of Gout:

Kidney stones made of urate crystals may form in the kidneys causing
damage. In long-standing cases, urate crystals may harden and form
nodules beneath the skin. These nodules are called tophi, and can form
in the hands, fingers, feet, elbows and ankles.

Treatment Options:
1. During an acute gout attack, patients are usually given colchicine tablets on the first day.


2. Alternately, doctors may prescribe pain relievers such as ibuprofen or indomethacin during the acute attack.



3. After the attack is over, patients are usually maintained on
medicines that block uric acid production. These include Allopurinol or
Febuxostat tablets, both of which lowers uric acid levels. Possible side
effects of allopurinol are rash and a low blood count. Febuxostat might
cause a rash, nausea and reduced liver function. See you doctor first
before taking any of these medications.


4. Another option for
doctors is to inject corticosteroids directly into the inflamed joint.
This may help control inflammation in the joint area.

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