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Gout
Gout is a form of arthritis caused by hyperuricemia. Hyperuricemia is
defined as a plasma urate (uric acid) level greater than 420 μmol/L (7.0
mg/dL); hyperuricemia is a cardinal feature of gout and necessary for
gout although a high uric acid level does not necessarily mean a person
will develop gout.
Etiology
People with gout have either an increased production of uric acid or an
impaired excretion of uric acid, or a combination of the two.
High uric acid levels are associated with age, obesity, type IV
hyperlipidaemia, diabetes mellitus, ischaemic heart disease and
hypertension. Sometimes, a person can inherit a genetic predisposition
from their families.
Symptoms and signs
The classical picture is of excruciating pain of sudden onset in only
one joint, usually the big toe (75% of first attacks are the first
metatarsal-phalangeal joint).
Diagnosis
A definitive diagnosis of gout is from microscopy of joint fluid
aspirated from the joint (this test may be difficult to perform) to
demonstrate intracellular monosodium urate crystals in synovial fluid
polymorphonuclear leukocytes.
Serum urate levels are usually raised. Serum urea and creatinine may be
raised if there is any renal impairment.
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Treatment
Acutely, first line treatment should be pain relief. Once the diagnosis
has been confirmed, the drugs of choice are colchicine, nonsteroidal
anti-inflammatory drugs (NSAIDs), or intraarticular glucocorticoids.
Long term treatment is antihyperuricemic therapy. Dietary change can
make a small contribution to lowering the plasma urate level if a diet
low in purines is considered. The mainstay of this approach, however, is
the drug allopurinol, a xanthine oxidase inhibitor, which directly
reduces the production and increases urinary excretion of uric acid.
The decision to use allopurinol is often a lifelong one. Patients have
been known to relapse into acute arthritic gout when they stop taking
their allopurinol, as the changing of their serum urate levels seems to
cause crystal precipitation.
Low Purine Diet:
cherries have been shown to reduce uric acid
strawberries are also reputed to be beneficial
avoid foods high in purines, that is from protein sources
limit meats to one serving a day
Never eat:
sweetbreads, kidneys, liver, brains, or other offal meats
sardines
anchovies
meat extracts, consomm?, and gravies
Use sparingly:
asparagus, beans, lentils, peas, mushrooms, cauliflower, spinach,
rhubarb
Avoid dehydration:
Drink plenty of liquids, especially water, to dilute and assist
excretion of urates;
Use diuretic foods or medicines like aspirin, vitamin C, tea and alcohol
sparingly.
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