"GOUT" ..... is that what troubling you there?....
Compassion is in the Heart of Our thought
GOUT … is that what paining me !
Well this what most of the time is the hidden disease which even dodge the good clinical skill . This is a form of crystal arthropathy and characterized by a swollen, redness of the joints along with its severe painful movements.
The reason for all these is FLUCTUTATING level of the uric acid in the blood which later precipitate as crystals in the joints this cause the inflammation.
- Redness around the joint or the foci.
- Painful swelling or painful joint (classically at great toe Joint ). The severity may fluctuate on and off with certain food habits particularly night binge (alcohol). Even while sleeping in the night.
- Hot /warm skin.
- Weight. More the weight more the protein metabolism, more the load and frequent chocking of kidney
- Medical conditions. untreated high blood pressure and chronic conditions such as diabetes, obesity, metabolic syndrome, and heart and kidney diseases, cancer.
- Certain medications. Low-dose aspirin and some anti hypertensive drugs — including thiazide diuretics, angiotensin-converting enzyme (ACE) inhibitors and beta blockers causes hyperuricemia.
- Hereditary gout. If your other family members also had gout, you’re are more likely to develop the disease.
- Age and sex. Gout occurs more often in men, primarily because women tend to have lower uric acid levels. After menopause, however, this difference stands equalizer Men are also more likely to develop gout earlier — usually between the ages of 30 and 50 — whereas women generally develop signs and symptoms after menopause.
- Recent surgery or trauma. Experiencing recent surgery or trauma can sometimes trigger a gout attack. In some people, a vaccination may trigger a gout attack.
- Clinically – Recurrent episode or acute case of swollen ,red and tender joint.
- Serologically – Raised Inflammatory parameters i.e. Neutrophils, ESR ,CRP,URIC ACID >6mg/dl , hyperuricemia ( Normal plasma urate 2-6mg/dl).
- Microscopy of the Joint’s fluid- Your doctor may use a needle to draw fluid from your affected joint.
- Ultrasound:- This test uses sound waves to detect urate crystals in joints or of tophi.
- Radiologically – Erosion of joint and irregular joint coverage (the Cartilage erosion). Loss of morphology of the joint.
- Dual-energy computerized tomography (DECT):- This test combines X-ray images taken from many different angles to visualize urate crystals in joints.
Management:- Two objectives
- First-To control the ongoing inflammation
- Cold compression, rest and stop all above triggering factors . Exercise lifestyle.
- Pain killers- Indomethacin /Piroxicam are the best among the NSAID (Non Steroid Anti Inflammatory Drugs )for this work.
- Colchicine s the first line of drug, under medical supervision be started 1 mg with titration to .5mg next 2 to 3 hourly if required to maximum 3 dose a day.
- Steroid i.e prednisolone is to control this acute attack.
- Second-To prevent future recurrent attacks.
- Medications that block uric acid production e.g.
2. Medications that improve uric acid removal/Excretion.
All have their side effects so no self medication please.