Gout

Overview
Gout is a condition characterized by an abnormal metabolism of uric acid. People with gout either produce too much uric acid, or have a problem in removing it. The possible consequences of this buildup of uric acid in the body, including:-

1. acute and chronic gouty arthritis,
2. kidney stones, and
3. deposits of uric acid (tophi) in the skin and other tissues.

Causes
Uric acid is generated as the body's tissues are broken down during normal cell turnover. Some people with gout generate too much uric acid (10%) and others with gout do not effectively eliminate their uric acid into the urine (90%). If your parents have gout, then you have a 20% chance of developing it. Intake of alcoholic beverages, especially beer, increases the risk for gout. Diets rich in red meats, internal organs, yeast, and oily fish increase the risk for gout.

Symptoms
The most common symptoms are pain and inflammation in the joints, swelling and feeling of pressure in the area where the swelling has occurred. Uric acid crystals can form outside joints, can be found in the earlobe, elbow, and Achilles tendon. Typically, these collections are not painful but can be a valuable clue for the diagnosis. Kidney stones are more frequent in patients with gout.

When to Seek Medical Care
Anyone who has a sudden onset of a hot, red, swollen joint should seek medical care, either with a primary-care physician, or with a rheumatologist (arthritis specialist). Attacks of abdominal pain due to kidney stones (renal colic) may also be related to gout.

Exams and Tests

1. Joint aspiration (most important and ultimate method) - A needle is inserted into the joint to withdraw a sample of fluid for testing, to see if there are gout crystals or bacterial infection present.
2. Blood tests - to look at your cell counts, uric acid levels (not reliable), kidney function, etc.
3. Radiographs/X-rays - to assess underlying joint damage, especially in patients who have had multiple episodes of gouty arthritis.

Treatment
1.   Self-Care at Home

• Take medications as prescribed.
• While a joint is hot and swollen, you may want to use a cane or similar support to keep your weight off that joint.
• Ice packs can be helpful in relieving pain and reducing inflammation.
• Maintaining adequate hydration is key for minimizing attacks.

2.   Medications
      While some medications are used to treat the hot, swollen joint, other medications are used to
      prevent  further attacks of gout.
3.   Surgery - is rarely needed for gout unless significant joint damage has occurred from lack of effective 
       treatment.

Prevention
If you are at risk for gout, you should

• eat a low-cholesterol, low-fat diet.
• slowly lose weight. This can lower your uric acid levels. Losing weight too rapidly can occasionally     precipitate gout attacks.
• restrict your intake of alcohol, especially beer.
• stay hydrated.
• adjust your intake of dairy products, such as nonfat milk and yogurt, because they can lower the frequency of gout attacks.